© 2002 by European Society of Cardiology
The electromechanical effects of pacing at different sites within the right atrium
1Department of Cardiology, Royal Shrewsbury Hospital Shropshire, SY3 8XQ, UK; 2Department of Cardiology, St Thomas's Hospital London, SE1 7EH, UK; 3Department of Cardiology, Queen Elizabeth Hospital Birmingham, B15 2TH, UK; 4Department of Cardiology, Maidstone Hospital Kent, ME16 9QQ, UK
AIMS: To compare high right atrium (HRA) with right atrial appendage (RAA) pacing with respect to atrial electromechanical function.
METHODS: Eleven patients undergoing elective electrophysiological studies were studied in order directly to compare atrial conduction acutely associated with HRA and RAA pacing. Twenty-five patients with chronically implanted, active fixation leads in the HRA were compared with an age and sex matched group of 25 patients with chronically implanted, passive fixation leads in the RAA. For both studies recordings were taken in sinus rhythm then repeated when paced. Measured time intervals were intra- and interatrial activation times, P wave duration and time to onset of atrial systolic blood flow.
RESULTS: Right atrial pacing, when compared with sinus rhythm, significantly prolongs the interatrial activation time, the P wave duration and the time to onset of right and left atrial blood flow irrespective of site paced. Comparing the RAA group with the HRA group, there were no statistical differences for any of the measured parameters.
CONCLUSION: High right atrial free wall or the right atrial appendage pacing, when compared with sinus rhythm, is significantly detrimental to atrial electromechanical function. There is, however, no demonstrable difference between the two sites.
Key Words: High right atrial free wall pacing, right atrial appendage pacing, intra-atrial activation time, inter-atrial activation time, P wave duration, time to onset of atrial systolic bloodflow
[1] Lewis T, Oppenheimer BS, Oppenheimer A. The site of origin of the mammalian heart beat: The pacemaker in the dog. Heart 1910; 2: 147–169.
[2] Trautwein W and Uchizono K. Electron microscopic and electrophysiologic study of the pacemaker in the sino-atrial node of the rabbit heart. Z Zellforsch 1963; 61: 96–109.[CrossRef][Web of Science][Medline]
[3] James TN. The connecting pathways between the sinus node and the A-V node and between the right and left atrium in the human heart. Am Heart J 1963; 66: 498–508.[CrossRef][Web of Science][Medline]
[4] Wenckebach KF. Beitrage zur Kenntnis der menschlichen Herztatigkeit. Archiv fur Physiologie 1907; 2: 1–24.
[5] Bachmann G. The inter-auricular time interval. Am J Physiol 1916; 41: 309–320.
[6] Janse ML, Anderson RH, Van Capelle FJL, et al. A combined electrophysiological and anatomical study of the human fetal heart. Am Heart J 1976; 91: 556–562.[CrossRef][Web of Science][Medline]
[7] Wang K, Xiao HB, Fujimoto S, et al. Atrial electromechanical sequence in normal subjects and patients with DDD pacemakers. Br Heart J 1995; 74: 403–407.
[8] Braunwald E, Fishman AP, Cournand A. Time relationship of dynamic events in the cardiac chambers, pulmonary artery and aorta in man. Circ Res 1955; 4: 100–107.
[9] Sagie A, Benjamin EJ, Galderisi M, et al. Reference values for Doppler indexes of left ventricular diastolic filling in the elderly. J Am Soc Echocard 1993; 6: 570–576.[Medline]
[10] Kuo LC, Quinones MA, Rokey R, et al. Quantification of atrial contribution to left ventricular filling by pulsed Doppler echocardiography and the effect of age in normal and diseased hearts. Am J Cardiol 1987; 59: 1174–1178.[CrossRef][Web of Science][Medline]
[11] Ausubel K, Klementowicz P, Furman S. Interatrial conduction during cardiac pacing. Pacing Clin Electrophysiol 1986; 9: 1026–1031.[CrossRef][Medline]
[12] Camous J, Raybaud F, Dolisi C, et al. Interatrial conduction in patients undergoing AV stimulation: Effects of increasing right atrial stimulation rate. Pacing Clin Electrophysiol 1993; 16: 2082–2087.[CrossRef][Medline]
[13] Bennett DH. Comparison of the acute effects of pacing the atrial septum, right atrial appendage, coronary sinus os, and the latter two sites simultaneously on the duration of atrial activation. Heart 2000; 84: 193–196.
[14] Jamidar H, Goli V, Reynolds D. The right atrial free wall: An alternative pacing site. Pacing Clin Electrophysiol 1993; 16: 959–963.[CrossRef][Medline]
[15] Keith A and Flack A. The form and nature of the muscular connections between the primary divisions of the vertebrate heart. J Anat Physiol 1907; 41: 172–189.[Medline]
[16] Anderson KR, Ho SY, Anderson RH. Location and vascular supply of sinus node in human heart. Br Heart J 1979; 41: 28–32.
[17] Truex RC, Smythe MQ, Taylor MJ. Reconstruction of the human sinoatrial node. Anat Rec 1967; 159: 371–378.[CrossRef][Medline]
[18] Fitzgerald DM, Hawthorne HR, Crossley GH, et al. P wave morphology during atrial pacing along the atrioventricular ring. ECG localisation of the site of origin of retrograde atrial activation. J Electrocardiol 1996; 29: 1–10.[Medline]
[19] Scherlag BJ, Lau SH, Helfant RH, et al. Catheter technique for recording His bundle activity in man. Circulation 1969; 39: 13–18.
[20] Samet P, Bernstein WH, Levine S, et al. Haemodynamic effects of tachycardias produced by atrial and ventricular pacing. Am J Med 1965; 39: 905.[Medline]
[21] Hammond I. The prevalence and correlates of echocardiographic left ventricular hypertrophy among employed patients with uncomplicated hypertension. J Am Coll Cardiol 1988; 7: 639–650.
[22] Katsivas A, Manolis AG, Lazaris E, et al. Atrial septal pacing to synchronise atrial depolarization in patients with delayed interatrial conduction. Pacing Clin Electrophysiol 1998; 21: 2220–2225.[CrossRef][Medline]
[23] Latour H and Puech P. L'Electrocardiographie endocavitaire 1957; Paris Masson & Cie.
[24] Puech P. The P wave. Correlation of surface and intra atrial electrograms in complex electrocardiography. Cardiovasc clin 1974; 6: 43–68.[Medline]
[25] Fischer J. Control of atrial tachyarrhythmias using cardiac pacemakers. In Touboul P and Waldo A (Eds.). Atrial arrhythmias: Current concepts and management 1990; St Louis Mosby year book pp. 400–410.
[26] Truex RC. The sinoatrial node and its connections with the atrial tissues. In Wellens HJJ, Lie KI, Janse MJ (Eds.). The conduction system of the heart: Structure, function and clinical implications 1976; Philadelphia Lea & Febiger pp. 209–226.
[27] Roberts DE, Hersh LT, Scher AM. Influence of cardiac fiber orientation on wave-front voltage, conduction velocity and tissue resistivity in the dog. Circ Res 1979; 44: 701–712.
[28] Ritter P and Fischer W. Cardiac pacing in clinical practice 1998; Berlin Springer pp. 19–21.
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