Bifocal versus unifocal right atrial pacing under plasma level controlled sotalol to prevent atrial fibrillation in patients with symptomatic sinus bradycardia and paroxysmal atrial fibrillation.
OBJECTIVE
Bifocal right atrial pacing (BP) has been reported to increase arrhythmia-free intervals in patients with paroxysmal atrial fibrillation (PAF) under antiarrhythmic drugs. This study compares AF burden with unifocal pacing (UP) vs BP under sotalol.


METHODS
In 19 patients with PAF a DDDR pacemaker with right atrial lateral and CS ostial leads was implanted. Sotalol was initiated. After a 3 month back-up pacing period patients were randomized to continuous UP or BP for 3 months and crossed over for 3 more months. Primary endpoint was AF burden. Secondary endpoints included number of episodes, time to first recurrence and safety of BP.


RESULTS
The intention to treat analysis revealed 12.4% AF during back-up, 6.2% during UP and BP (p=0.91 UP vs BP, p=0.08 back-up vs UP and p=0.07 back-up vs BP). Per protocol analysis showed no advantage of either pacing mode (UP 4.8% and BP 5.4% AF, p=0.64). Overdrive pacing reduced AF burden to 6.2 vs 8.8% during back-up (p=0.09). Septal lead dislodgement occurred in 3 patients.


CONCLUSIONS
Atrial pacing tends to reduce AF burden in patients with PAF under sotalol. An incremental effect of BP vs UP cannot be confirmed. BP may be complicated by elevated lead dislodgement rates.
Stockburger
M
M
Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Department of Cardiology, Augustenburger Platz 1, 13353 Berlin, Germany. martin.stockburger@charite.de
Gerhardt
L
L
Helms
S
S
Schlegl
M
M
Butter
C
C
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage* / Q000097:blood*; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000628:therapy*; D001919:Bradycardia / Q000503:physiopathology / Q000628:therapy*; D003131:Combined Modality Therapy; D018592:Cross-Over Studies; D004562:Electrocardiography; D004567:Electrodes, Implanted; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D012008:Recurrence; D012804:Sick Sinus Syndrome / Q000503:physiopathology / Q000628:therapy*; D016037:Single-Blind Method; D012849:Sinoatrial Node / Q000503:physiopathology; D013015:Sotalol / Q000008:administration & dosage* / Q000097:blood*
D000889:Anti-Arrhythmia Agents; D013015:Sotalol