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Europace 2002 4(4):431-437; doi:10.1053/eupc.2002.0256
© 2002 by European Society of Cardiology
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The electromechanical effects of pacing at different sites within the right atrium

M. R. D. Belham1, J. Gill2, M. D. Gammage3 and P. M. Holt4

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


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