title: The risk of atrial fibrillation during right ventricular pacing.
abstract: OBJECTIVE
  Right ventricular pacing adversely affects left atrial (LA) structure and function that may trigger atrial fibrillation (AF). This study compares the occurrence of persistent/permanent AF during long-term Hisian area (HA), right ventricular septal (RVS), and right ventricular apex (RVA) pacing in patients with complete/advanced atrioventricular block (AVB).
  
  
  RESULTS
  We collected retrospective data from 477 consecutive patients who underwent pacemaker implantation for complete/advanced AVB. Ventricular pacing leads were located in the HA, RVS, and RVA in 148, 140, and 189 patients, respectively. The occurrence of persistent/permanent AF was observed in 114 (23.9%) patients (follow-up 58.5 ± 26.5 months). Hisian area groups presented a lower rate of AF occurrence (16.9%) compared with RVS and RVA groups (25.7 and 28.0%, respectively), P = 0.049. Cox's proportional hazard model was used to estimate HR. The risk of persistent/permanent AF was significantly lower in the patients paced from HA compared with those paced from RVA, HR = 0.28 (95% CI 0.16-0.48, P = 0.0001). The RVS and RVA pacing groups showed a similar AF risk: HR 1.04 (95% CI 0.66-1.64, P = 0.856). Other independent predictors of persistent/permanent AF occurrence included previous (before device implantation) paroxysmal AF (HR = 4.08; 95% CI 3.15-7.31, P = 0.0001), LA diameter, and age, whereas baseline bundle-branch block was associated with a lower risk of AF occurrence (HR = 0.56; 95% CI 0.35-0.81, P = 0.003).
  
  
  CONCLUSIONS
  HA pacing compared with RVA or RVS pacing seems to be associated with a lower risk of persistent/permanent AF occurrence. The risk of persistent/permanent AF was similar in the RVA vs. RVS groups.
authors.affiliation: Department of Cardiology, Rovigo General Hospital, Via Tre Martiri, 140 45100 Rovigo, Italy gian.past@libero.it.
authors.forename: Gianni
authors.initials: G
authors.lastname: Pastore
authors.affiliation: Department of Cardiology, Rovigo General Hospital, Via Tre Martiri, 140 45100 Rovigo, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Zanon
authors.affiliation: Department of Cardiology, Rovigo General Hospital, Via Tre Martiri, 140 45100 Rovigo, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Baracca
authors.affiliation: Department of Cardiology, Rovigo General Hospital, Via Tre Martiri, 140 45100 Rovigo, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Aggio
authors.affiliation: Formerly MEdtronic Bakken Research Center, Maastricht, The Netherlands.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Corbucci
authors.affiliation: Department of Cardiology, Rovigo General Hospital, Via Tre Martiri, 140 45100 Rovigo, Italy.
authors.forename: Graziano
authors.initials: G
authors.lastname: Boaretto
authors.affiliation: Department of Cardiology, Rovigo General Hospital, Via Tre Martiri, 140 45100 Rovigo, Italy.
authors.forename: Loris
authors.initials: L
authors.lastname: Roncon
authors.affiliation: Department of Molecular Medicine, University of Padua, Padova, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Noventa
authors.affiliation: Florida Heart Rhythm Institute, Tampa, FL, USA.
authors.forename: S Serge
authors.initials: SS
authors.lastname: Barold
mesh_terms: D000200:Action Potentials; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D016279:Atrial Function, Left; D054537:Atrioventricular Block / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D002036:Bundle of His / Q000503:physiopathology; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects*; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006339:Heart Rate; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016278:Ventricular Function, Right; D054088:Ventricular Septum / Q000503:physiopathology
keywords: Atrial fibrillation; Hisian area pacing; Right ventricular apical pacing; Right ventricular septal pacing