Atrial function during different multisite atrial pacing modalities in patients with bradycardia--tachycardia syndrome.
BACKGROUND
Multisite atrial pacing (MAP) was introduced to improve atrial electrical synchrony and prevent recurrence of atrial fibrillation (AF).


RESULTS
In the present study there were 57 patients with sinus node disease, AF recurrence and prolonged P-wave on ECG with 2 MAP modalities. In all patients 1 lead was implanted in the coronary sinus (CS) ostium area. In the right atrial appendage (RAA)+CS group (28 patients) the other atrial lead was in the RAA, and in the BB+CS group (29 patients) in the Bachmann's bundle (BB) region. Tissue Doppler was used to register the electromechanical delay (EMD) in the atrial walls and estimate the atrial contraction synchrony. Cardiac output and myocardial performance index did not differ during the 2 MAP modalities. During BB+CS, in comparison with RAA+CS pacing, the peak of the mitral atrial wave occurred earlier (P<0.01), the usual right-left atrial contraction sequence was reversed more frequently (P<0.004), all atrial EMDs except for the lateral left atrium (LA) were shorter (P<0.05), and LA synchrony was greater (P<0.001).


CONCLUSIONS
In patients treated with MAP, implanting 1 of the atrial leads in the BB area instead of the RAA has no influence on global cardiac hemodynamics, but does result in earlier LA contraction, and reversal of the typical right-left atrial contraction sequence, as well as providing greater LA contraction synchrony.
Lewicka-Nowak
Ewa
E
Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland. elew@gumed.edu.pl
Dabrowska-Kugacka
Alicja
A
Rucinski
Piotr
P
Kozlowski
Dariusz
D
Raczak
Grzegorz
G
Kutarski
Andrzej
A
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy; D016275:Atrial Function; D001919:Bradycardia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D018619:Echocardiography, Doppler, Pulsed; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D012008:Recurrence; D013577:Syndrome; D013610:Tachycardia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*