Does Bachmann's bundle pacing prevent atrial fibrillation in myotonic dystrophy type 1 patients? A 12 months follow-up study.
OBJECTIVE
Paroxysmal atrial arrhythmias occur in myotonic dystrophy type 1 (MD1) patients frequently. Pacemaker (PM) including detailed diagnostic functions may facilitate the diagnosis and management of frequent paroxysmal atrial tachyarrhythmias that may remain undetected during conventional clinical follow-up. Aim of our study was to evaluate the preventive effects of interatrial septum pacing in the Bachmann's Bundle region on atrial fibrillation (AF) in MD1 patients during 12 months follow up period.


RESULTS
Thirty MD1 patients (age 50.3 +/- 7.3; 11 F) who underwent dual chamber PM implantation were randomized at implantation to receive right atrial appendage pacing (16 patients) or Bachmann's bundle pacing (14 patients). No statistically significant difference in the electrical parameters (P wave amplitude, pacing threshold and lead impedance) was found between the two groups at implantation. Patients were followed at 1 month, 3 months, and every 6 months thereafter. They underwent clinical assessment, a standard 12-lead ECG and assessment of device performance at every visit. We counted the number of episodes of atrial arrhythmia occurred during the collection period and the duration of each episode. At 12 months of follow-up, no statistically significant differences in the number of AF episodes or in AF duration were found. Lead parameters remained stable over time and there were no displacements of the electrodes after implantation.


CONCLUSIONS
Implantation of an atrial-active fixation lead on the atrial septum is safe and feasible. However, this study showed no significant difference between septal pacing and high atrial pacing, using the endpoints of AF duration and number of AF episodes.
Nigro
Gerardo
G
Cardiology, Second, University of Naples - Monaldi Hospital, Naples, Italy.
Russo
Vincenzo
V
Politano
Luisa
L
Della Cioppa
Nadia
N
Rago
Anna
A
Arena
Giulia
G
Papa
Andrea Antonio
AA
Paoli
Lucrezia Delli
LD
de Chiara
Annabella
A
Russo
Maria Giovanna
MG
Golino
Paolo
P
Calabrò
Raffaele
R
D020517:Atrial Appendage / Q000294:innervation / Q000503:physiopathology; D001281:Atrial Fibrillation / Q000517:prevention & control*; D054087:Atrial Septum / Q000294:innervation / Q000503:physiopathology; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009223:Myotonic Dystrophy / Q000628:therapy*; D011446:Prospective Studies