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Europace Advance Access originally published online on November 16, 2007
Europace 2007 9(12):1124-1128; doi:10.1093/europace/eum242
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org

PACING FOR ATRIAL FIBRILLATION

Septal atrial pacing for the prevention of atrial fibrillation

Nina Hakacova1, Dusan Velimirovic2, Peter Margitfalvi3, Robert Hatala3 and Thomas A. Buckingham3,*

1 Children's Cardiac Centre, Bratislava, Slovak Republic; 2 Institute for Cardiovascular Diseases, Clinical Center of Serbia, Belgrade, Serbia and Montenegro; 3 Slovak Cardiovascular Institute, Pod Krasnou Horkou 1, Bratislava 83348, Slovak Republic

Aims: Atrial fibrillation (AF) produces significant morbidity and mortality. The current method of permanent pacing of the right atrium (RA) may cause delayed interatrial conduction and predispose to AF. We hypothesized that atrial septal pacing would reduce AF compared with high RA pacing.

Methods and results: The patients were randomized into two groups. After randomization, patients received a dual-chamber rate-responsive device capable of mode-switching with advanced telemetry features. Devices were programmed in a standardized manner. To be eligible, the patients were required to have a conventional indication for a permanent pacemaker and recurrent paroxysmal AF. Group 1 was paced from high RA and Group 2 was paced from the atrial septum. Analysis of 43 patients who have completed 6 months of follow-up and 22 patients who completed 12 months of follow-up showed no significant differences in the number of mode-switching episodes or in AF burden between groups (P = NS by Mann–Whitney) although there was a trend for less AF with septal pacing. There were no differences in thresholds, sensing, or lead impedance. Lead parameters remained stable over time and there were no displacements of the electrodes after implantation. No patient experienced lead-related complications. A significant variability in AF burden was noted in this patient population.

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.

Key Words: Atrial fibrillation, Atrial septal pacing, High atrial pacing, Bachmann’s bundle

* Corresponding author. Tel: +421 905 978573; fax: +421 2 6545 8182. E-mail address: buckint{at}gmail.com

Manuscript submitted 14 November 2006. Accepted after revision 12 October 2007.


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