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.
Cardiology, Second, University of Naples - Monaldi Hospital, Naples, Italy.
Gerardo
G
Nigro
Vincenzo
V
Russo
Luisa
L
Politano
Nadia
N
Della Cioppa
Anna
A
Rago
Giulia
G
Arena
Andrea Antonio
AA
Papa
Lucrezia Delli
LD
Paoli
Annabella
A
de Chiara
Maria Giovanna
MG
Russo
Paolo
P
Golino
Raffaele
R
Calabrò
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