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Cronin EM, Vedage N, Israel CW. Alternative atrial pacing site to improve cardiac function: focus on Bachmann's bundle pacing. Eur Heart J Suppl 2023; 25:G44-G55. [PMID: 37970517 PMCID: PMC10637835 DOI: 10.1093/eurheartjsupp/suad118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Pacing from the right atrial appendage (RAA) prolongs the P wave duration and can induce interatrial and especially left-sided atrio-ventricular dyssynchrony. Pacing from Bachmann's bundle closely reproduces normal physiology and has the potential to avoid the electromechanical dysfunction associated with conventional RAA pacing. Interatrial conduction delay is associated with an increased risk of stroke, heart failure, and death. In addition to a reduction in atrial fibrillation, Bachmann's bundle pacing has emerging applications as a hemodynamic pacing modality. This review outlines the pathophysiology of atrial conduction disturbances and their potential remedies and provides the reader with a practical guide to implementing Bachmann's bundle pacing with an emphasis on the recapitulation of normal electrical and mechanical function.
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Affiliation(s)
- Edmond M Cronin
- Section of Cardiology, Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, USA
| | - Natasha Vedage
- Section of Cardiology, Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, USA
| | - Carsten W Israel
- Department of Medicine—Cardiology, Diabetology, and Nephrology, Bethel-Clinic, Bielefeld, Germany
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Liu Y, Zheng Y, Tse G, Bazoukis G, Letsas K, Goudis C, Korantzopoulos P, Li G, Liu T. Association between sick sinus syndrome and atrial fibrillation: A systematic review and meta-analysis. Int J Cardiol 2023; 381:20-36. [PMID: 37023861 DOI: 10.1016/j.ijcard.2023.03.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/17/2023] [Accepted: 03/31/2023] [Indexed: 04/08/2023]
Abstract
AIMS Sick sinus syndrome (SSS) and atrial fibrillation (AF) frequently coexist and show a bidirectional relationship. This systematic review and meta-analysis aimed to decipher the precise relationship between SSS and AF, further exploring and comparing different therapy strategies on the occurrence or progression of AF in patients with SSS. METHODS AND RESULTS A systematic literature search was conducted until November 2022. A total of 35 articles with 37,550 patients were included. Patients with SSS were associated with new-onset AF compared to those without SSS. Catheter ablation was associated with a lower risk of AF recurrence, AF progression, all-cause mortality, stroke and hospitalization of heart failure compared to pacemaker therapy. Regarding the different pacing strategies for SSS, VVI/VVIR has higher risk of new-onset AF than DDD/DDDR. No significant difference was found between AAI/AAIR and DDD/DDDR, as well as between DDD/DDDR and minimal ventricular pacing (MVP) for AF recurrence. AAI/AAIR was associated with higher risk of all-cause mortality when compared to DDD/DDDR, but lower risk of cardiac death when compared to DDD/DDDR. Right atrial septum pacing was associated with a similar risk of new-onset AF or AF recurrence compared to right atrial appendage pacing. CONCLUSION SSS is associated with a higher risk of AF. For patients with both SSS and AF, catheter ablation should be considered. This meta-analysis re-emphasizes that high percentage of ventricular pacing should be avoided in patients with SSS in order to decrease AF burden and mortality.
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Affiliation(s)
- Ying Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Yi Zheng
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China; Kent and Medway Medical School, University of Kent and Canterbury Christ Church University, Canterbury, Kent, UK; School of Nursing and Health Studies, Hong Kong, Metropolitan University, Hong Kong, China
| | - George Bazoukis
- Department of Cardiology, Larnaca General Hospital, Inomenon Polition Amerikis, Larnaca, Cyprus; Department of Basic and Clinical Sciences, University of Nicosia Medical School, 2414 Nicosia, Cyprus
| | - Konstantinos Letsas
- Laboratory of Cardiac Electrophysiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Christos Goudis
- Department of Cardiology, Serres General Hospital, 45110 Serres, Greece
| | | | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China.
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Mercik J, Gajek-Marecka A, Zawadzki JM, Sławuta A, Gajek J. Patient with sick sinus syndrome and implanted dual-chamber pacemaker with reduced P-wave duration following low interatrial septal pacing: Case report. Medicine (Baltimore) 2021; 100:e27076. [PMID: 34477142 PMCID: PMC8415954 DOI: 10.1097/md.0000000000027076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 08/12/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION A dual-chamber pacemaker (DDD/R) for a sinus node disease is sometimes referred to as a physiological pacemaker as it maintains atrioventricular synchrony, however several clinical trials have proved its inferiority to a nonphysiological single-chamber ventricular back-up pacing. PATIENT CONCERNS A subject of the study is a 74-year-old woman with a sick sinus syndrome (SSS) and a previously implanted physiological DDD/R pacemaker. The SSS was diagnosed because of patient's very slow sinus rhythm of about 36 bpm, and due to several episodes of dizziness. After the DDD/R implantation the percentage of atrial pacing approached 100%, with almost none ventricular pacing. DIAGNOSES Sick sinus syndrome, complete Bachmann's bundle block, atrial fibrillation, atrial flutter. INTERVENTIONS The patient was previously implanted with a physiological DDD/R pacemaker. Several years after the implantation, the atrial fibrillation was diagnosed and the pulmonary vein isolation was then performed by cryoablation. During the follow-up after pulmonary vein isolation, the improvement of mitral filling parameters was assessed using echocardiography. Shortly thereafter the patient developed the persistent paroxysm of a typical atrial flutter which was successfully terminated using a radiofrequency ablation. No recurrence thereof has been observed ever since (24 months). OUTCOMES The atrial electrode of the pacing system was implanted within the low interatrial septal region that resulted in a reduced P-wave duration compared to native sinus rhythm P-waves. The said morphology was deformed because of the complete Bachmann bundle block. That approach, despite a nonphysiological direction of an atrial activation, yielded relatively short P-waves (paced P-wave: 179 ms vs intrinsic sinus P-wave: 237 ms). It also contributed to a significantly shorter PR interval (paced PR: 204 ms vs sinus rhythm PR: 254 ms). CONCLUSIONS The authors took into consideration different aspects of alternative right atrial pacing sites. This report has shown that in some patients with a sinus node disease, low interatrial septal pacing can reduce the P-wave duration but does not prevent from the development of atrial arrhythmias.
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Affiliation(s)
- Jakub Mercik
- Department of Emergency Medicine, Wroclaw Medical University, Wroclaw, Poland
| | | | - Jacek Marcin Zawadzki
- Department of Anesthesia, Critical Care and Emergency Medicine, Collegium Medicum of University in Zielona Góra, Zielona Góra, Poland
| | - Agnieszka Sławuta
- Department of Internal and Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Jacek Gajek
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
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Riedlbauchová L, Durdil V, Honěk J, Veselka J. Nonpharmacological Treatment of Atrial Fibrillation: What Is the Role of Device Therapy? Int J Angiol 2020; 29:113-122. [PMID: 32476811 DOI: 10.1055/s-0040-1708529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Atrial fibrillation is the most common arrhythmia in the adult population, and its incidence and prevalence are still rising. Cardiac devices are widely used in clinical practice in the management of various rhythm disturbances and heart failure treatment. Many patients who receive a pacemaker, implantable cardioverter-defibrillator, or cardiac resynchronization therapy also experience atrial fibrillation in the course of their life. Therefore, this review aims to describe the role of these devices in the treatment and prevention of atrial fibrillation in the device recipients. In addition, all these implantable devices also serve as permanent ECG (electrocardiogram) monitors, thus providing important information about the presence and characteristics of atrial fibrillation that may or may not be detected by the patient but can modify our therapeutical approach with regard to the stroke prevention.
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Affiliation(s)
- Lucie Riedlbauchová
- Department of Cardiology, Motol University Hospital, Prague, Czech Republic.,Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Václav Durdil
- Department of Cardiology, Motol University Hospital, Prague, Czech Republic.,Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jakub Honěk
- Department of Cardiology, Motol University Hospital, Prague, Czech Republic.,Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Josef Veselka
- Department of Cardiology, Motol University Hospital, Prague, Czech Republic.,Second Faculty of Medicine, Charles University, Prague, Czech Republic
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Technological and Clinical Challenges in Lead Placement for Cardiac Rhythm Management Devices. Ann Biomed Eng 2019; 48:26-46. [DOI: 10.1007/s10439-019-02376-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/25/2019] [Indexed: 01/29/2023]
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Kharbanda RK, Özdemir EH, Taverne YJ, Kik C, Bogers AJ, de Groot NM. Current Concepts of Anatomy, Electrophysiology, and Therapeutic Implications of the Interatrial Septum. JACC Clin Electrophysiol 2019; 5:647-656. [DOI: 10.1016/j.jacep.2019.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/26/2019] [Accepted: 04/30/2019] [Indexed: 12/28/2022]
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Munawar DA, Mahajan R, Agbaedeng TA, Thiyagarajah A, Twomey DJ, Khokhar K, O'Shea C, Young GD, Roberts-Thomson KC, Munawar M, Lau DH, Sanders P. Implication of ventricular pacing burden and atrial pacing therapies on the progression of atrial fibrillation: A systematic review and meta-analysis of randomized controlled trials. Heart Rhythm 2019; 16:1204-1214. [PMID: 30772532 DOI: 10.1016/j.hrthm.2019.02.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is common after pacemaker implantation. However, the impact of pacemaker algorithms in AF prevention is not well understood. OBJECTIVE The purpose of this study was to evaluate the role of pacing algorithms in preventing AF progression. METHODS A systematic search of articles using the PubMed and Embase databases resulted in a total of 754 references. After exclusions, 21 randomized controlled trials (8336 patients) were analyzed, comprising studies reporting ventricular pacing percentage (VP%) (AAI vs DDD, n = 1; reducing ventricular pacing [RedVP] algorithms, n = 2); and atrial pacing therapies (atrial preference pacing [APP], n = 14; atrial antitachycardia pacing [aATP]+APP, n = 3; RedVP+APP+aATP, n = 1). RESULTS Low VP% (<10%) lead to a nonsignificant reduction in the progression of AF (hazard ratio [HR] 0.80; 95% confidence interval [CI] 0.57-1.13; P = .21; I2 = 67%) compared to high VP% (>10%). APP algorithm reduced premature atrial complexes (PAC) burden (mean difference [MD] -1117.74; 95% CI -1852.36 to -383.11; P = .003; I2 = 67%) but did not decrease AF burden (MD 8.20; 95% CI -5.39 to 21.80; P = .24; I2 = 17%) or AF episodes (MD 0.00; 95% CI -0.24 to 0.25; P = .98; I2 = 0%). Similarly, aATP+APP programming showed no significant difference in AF progression (odds ratio 0.65; 95% CI 0.36-1.14; P = .13; I2 = 61%). No serious adverse events related to algorithm were reported. CONCLUSION This meta-analysis of randomized controlled trials demonstrated that algorithms to reduce VP% can be considered safe. Low burden VP% did not significantly suppress AF progression. The atrial pacing therapy algorithms could suppress PAC burden but did not prevent AF progression.
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Affiliation(s)
- Dian A Munawar
- Centre for Heart Rhythm disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia; Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Rajiv Mahajan
- Centre for Heart Rhythm disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia; Department of Cardiology, Lyell McEwin Hospital, Adelaide, Australia
| | - Thomas A Agbaedeng
- Centre for Heart Rhythm disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Anand Thiyagarajah
- Centre for Heart Rhythm disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Darragh J Twomey
- Centre for Heart Rhythm disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Kashif Khokhar
- Centre for Heart Rhythm disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Catherine O'Shea
- Centre for Heart Rhythm disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Glenn D Young
- Centre for Heart Rhythm disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Kurt C Roberts-Thomson
- Centre for Heart Rhythm disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Muhammad Munawar
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Dennis H Lau
- Centre for Heart Rhythm disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
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Gronda E. In memoriam Luigi Padeletti: a cardiologist with many human and scientific qualities. Eur J Heart Fail 2018. [DOI: 10.1002/ejhf.1296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Edoardo Gronda
- Clinical Cardiology and Heart Failure Research Unit, Cardiovascular Department; IRCCS MultiMedica; Milan Italy
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Low interatrial septal pacing: A simple method. Indian Heart J 2017; 69:725-730. [PMID: 29174249 PMCID: PMC5717316 DOI: 10.1016/j.ihj.2017.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 12/17/2016] [Accepted: 06/05/2017] [Indexed: 11/20/2022] Open
Abstract
Background Sinus node disease is associated with widespread structural and electrophysiological changes in the atria in addition to abnormalities at the sinus node. The atrial conduction disorder in patients with atrial pacing results in higher incidence of atrial fibrillation. Studies have shown that low interatrial septal pacing is superior to right atrial appendage pacing in preventing persistent or permanent atrial fibrillation in these patients. However, implantation of active fixation lead in low interatrial septal position is difficult and time consuming with conventional stylet, inhibiting application of this method in routine practice. Method The technique of implanting atrial pacing lead in low interatrial septum with hand-made stylet is presented in this study with emphasis on fluoroscopic landmark and electrocardiographic P wave pattern. Results The results indicate acute and short-term success of low interatrial septal pacing in 10 patients out of 11 patients without major complications. Pacing parameters during implantation and 3 months post procedure were within normal limits. Conclusion The initial favorable results of this study indicate low interatrial septal pacing with conventional active fixation lead using fluoroscopic landmark and electrocardiographic characteristics is feasible and reproducible with a simple technique.
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Das A. Electrocardiographic features: Various atrial site pacing. Indian Heart J 2017; 69:675-680. [PMID: 29054201 PMCID: PMC5650557 DOI: 10.1016/j.ihj.2017.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 08/28/2017] [Accepted: 08/31/2017] [Indexed: 11/22/2022] Open
Abstract
Atrial pacing is done for either symptomatic sinus node dysfunction (SND) or for maintenance of atrio-ventricular synchrony in a dual chamber pacemaker. Conventionally, atrial lead is placed in the right atrial appendage. Atrial conduction disorder in patients with permanent pacing results in higher incidence of atrial fibrillation. Atrial septal pacing has emerged as a solution to this problem. So, it is extremely important to understand the different features of paced P wave from various atrial pacing sites. Conventional right atrial appendage pacing in presence of atrial conduction disorder results in marked latency with prolonged P wave duration with reduced amplitude. The morphology is similar to sinus rhythm. Atrial septal pacing causes short and sharp P wave with negative polarity in inferior leads and positive polarity in lead V1 in lower septal pacing, whereas positive polarity in inferior leads and negative polarity in lead V1 during pacing from upper septum.
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Zhang L, Jiang H, Wang W, Bai J, Liang Y, Su Y, Ge J. Interatrial septum versus right atrial appendage pacing for prevention of atrial fibrillation. Herz 2017; 43:438-446. [DOI: 10.1007/s00059-017-4589-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/24/2017] [Accepted: 05/24/2017] [Indexed: 01/09/2023]
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Interatrial septal pacing to suppress atrial fibrillation in patients with dual chamber pacemakers: A meta-analysis of randomized, controlled trials. Int J Cardiol 2016; 219:421-7. [DOI: 10.1016/j.ijcard.2016.06.093] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 05/23/2016] [Accepted: 06/21/2016] [Indexed: 11/23/2022]
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Das A, Kahali D. Physiological cardiac pacing: Current status. Indian Heart J 2016; 68:552-8. [PMID: 27543481 PMCID: PMC4990729 DOI: 10.1016/j.ihj.2016.03.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/09/2016] [Accepted: 03/28/2016] [Indexed: 11/16/2022] Open
Abstract
Adverse hemodynamics of right ventricular (RV) pacing is a well-known fact. It was believed to be the result of atrio-ventricular (AV) dyssynchrony and sequential pacing of the atrium and ventricle may solve these problems. However, despite maintenance of AV synchrony, the dual chamber pacemakers in different trials have failed to show its superiority over single chamber RV apical pacing in terms of death, progression of heart failure, and atrial fibrillation (AF). As a consequence, investigators searched for alternate pacing sites with a more physiological activation pattern and better hemodynamics. Direct His bundle pacing and Para-Hisian pacing are the most physiological ventricular pacing sites. But, this is technically difficult. Ventricular septal pacing compared to apical pacing results in a shorter electrical activation delay and consequently less mechanical dyssynchrony. But, the study results are heterogeneous. Selective site atria pacing (atrial septal) is useful for patients with atrial conduction disorders in prevention of AF.
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Affiliation(s)
- Asit Das
- RMO-cum-Clinical Tutor, Department of Cardiology, IPGME&R and SSKM Hospital, Kolkata, India.
| | - Dhiman Kahali
- Senior Interventional Cardiologist, B. M. Birla Heart Research Centre, Kolkata, India
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Bianchi S, Rossi P, Schauerte P, Elvan A, Blomström-Lundqvist C, Kornet L, Gal P, Mörtsell D, Wouters G, Gemein C. Increase of Ventricular Interval During Atrial Fibrillation by Atrioventricular Node Vagal Stimulation. Circ Arrhythm Electrophysiol 2015; 8:562-8. [DOI: 10.1161/circep.114.002588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 04/08/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Stefano Bianchi
- From the Department of Cardiology, Az. Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy (S.B., P.R.); Department of Cardiology, RWTH Aachen University, Aachen, Germany (P.S.); Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands (A.E., P.G.); Department of Cardiology, Uppsala University, Uppsala, Sweden (C.B.-L., D.M.); Department of Research and Technology, Medtronic, Bakken Research Center, Maastricht, the Netherlands (L.K., G.W.); and Department of Cardiology and
| | - Pietro Rossi
- From the Department of Cardiology, Az. Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy (S.B., P.R.); Department of Cardiology, RWTH Aachen University, Aachen, Germany (P.S.); Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands (A.E., P.G.); Department of Cardiology, Uppsala University, Uppsala, Sweden (C.B.-L., D.M.); Department of Research and Technology, Medtronic, Bakken Research Center, Maastricht, the Netherlands (L.K., G.W.); and Department of Cardiology and
| | - Patrick Schauerte
- From the Department of Cardiology, Az. Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy (S.B., P.R.); Department of Cardiology, RWTH Aachen University, Aachen, Germany (P.S.); Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands (A.E., P.G.); Department of Cardiology, Uppsala University, Uppsala, Sweden (C.B.-L., D.M.); Department of Research and Technology, Medtronic, Bakken Research Center, Maastricht, the Netherlands (L.K., G.W.); and Department of Cardiology and
| | - Arif Elvan
- From the Department of Cardiology, Az. Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy (S.B., P.R.); Department of Cardiology, RWTH Aachen University, Aachen, Germany (P.S.); Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands (A.E., P.G.); Department of Cardiology, Uppsala University, Uppsala, Sweden (C.B.-L., D.M.); Department of Research and Technology, Medtronic, Bakken Research Center, Maastricht, the Netherlands (L.K., G.W.); and Department of Cardiology and
| | - Carina Blomström-Lundqvist
- From the Department of Cardiology, Az. Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy (S.B., P.R.); Department of Cardiology, RWTH Aachen University, Aachen, Germany (P.S.); Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands (A.E., P.G.); Department of Cardiology, Uppsala University, Uppsala, Sweden (C.B.-L., D.M.); Department of Research and Technology, Medtronic, Bakken Research Center, Maastricht, the Netherlands (L.K., G.W.); and Department of Cardiology and
| | - Lilian Kornet
- From the Department of Cardiology, Az. Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy (S.B., P.R.); Department of Cardiology, RWTH Aachen University, Aachen, Germany (P.S.); Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands (A.E., P.G.); Department of Cardiology, Uppsala University, Uppsala, Sweden (C.B.-L., D.M.); Department of Research and Technology, Medtronic, Bakken Research Center, Maastricht, the Netherlands (L.K., G.W.); and Department of Cardiology and
| | - Pim Gal
- From the Department of Cardiology, Az. Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy (S.B., P.R.); Department of Cardiology, RWTH Aachen University, Aachen, Germany (P.S.); Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands (A.E., P.G.); Department of Cardiology, Uppsala University, Uppsala, Sweden (C.B.-L., D.M.); Department of Research and Technology, Medtronic, Bakken Research Center, Maastricht, the Netherlands (L.K., G.W.); and Department of Cardiology and
| | - David Mörtsell
- From the Department of Cardiology, Az. Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy (S.B., P.R.); Department of Cardiology, RWTH Aachen University, Aachen, Germany (P.S.); Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands (A.E., P.G.); Department of Cardiology, Uppsala University, Uppsala, Sweden (C.B.-L., D.M.); Department of Research and Technology, Medtronic, Bakken Research Center, Maastricht, the Netherlands (L.K., G.W.); and Department of Cardiology and
| | - Griet Wouters
- From the Department of Cardiology, Az. Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy (S.B., P.R.); Department of Cardiology, RWTH Aachen University, Aachen, Germany (P.S.); Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands (A.E., P.G.); Department of Cardiology, Uppsala University, Uppsala, Sweden (C.B.-L., D.M.); Department of Research and Technology, Medtronic, Bakken Research Center, Maastricht, the Netherlands (L.K., G.W.); and Department of Cardiology and
| | - Christopher Gemein
- From the Department of Cardiology, Az. Ospedale S. Giovanni Calibita Fatebenefratelli, Rome, Italy (S.B., P.R.); Department of Cardiology, RWTH Aachen University, Aachen, Germany (P.S.); Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands (A.E., P.G.); Department of Cardiology, Uppsala University, Uppsala, Sweden (C.B.-L., D.M.); Department of Research and Technology, Medtronic, Bakken Research Center, Maastricht, the Netherlands (L.K., G.W.); and Department of Cardiology and
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Starek Z, Lehar F, Jez J, Wolf J, Novák M. Hybrid therapy in the management of atrial fibrillation. Curr Cardiol Rev 2015; 11:167-79. [PMID: 25028165 PMCID: PMC4356725 DOI: 10.2174/1573403x10666140713172231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 07/02/2014] [Accepted: 07/11/2014] [Indexed: 11/22/2022] Open
Abstract
Atrial fibrillation is the most common sustained arrhythmia. Because of the sub-optimal outcomes and associated risks of medical therapy as well as the recent advances in non-pharmacologic strategies, a multitude of combined (hybrid) algorithms have been introduced that improve efficacy of standalone therapies while maintaining a high safety profile. Antiarrhythmic administration enhances success rate of electrical cardioversion. Catheter ablation of antiarrhythmic drug-induced typical atrial flutter may prevent recurrent atrial fibrillation. Through simple ablation in the right atrium, suppression of atrial fibrillation may be achieved in patients with previously ineffective antiarrhythmic therapy. Efficacy of complex catheter ablation in the left atrium is improved with antiarrhythmic drugs. Catheter ablation followed by permanent pacemaker implantation is an effective and safe treatment option for selected patients. Additional strategies include pacing therapies such as atrial pacing with permanent pacemakers, preventive pacing algorithms, and/or implantable dual-chamber defibrillators are available. Modern hybrid strategies combining both epicardial and endocardial approaches in order to create a complex set of radiofrequency lesions in the left atrium have demonstrated a high rate of success and warrant further research. Hybrid therapy for atrial fibrillation reviews history of development of non-pharmacological treatment strategies and outlines avenues of ongoing research in this field.
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Affiliation(s)
| | | | | | | | - Miroslav Novák
- International Clinical Research Center, 1st Department of Internal Medicine - Cardioangiology, St. Anne's University Hospital Brno, Pekarska 53, 656 91 Brno, Czech Republic.
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Silva R, Pereira T, Martins V. Eficácia das terapias de pacing auricular antitaquicardia no tratamento da fibrilhação auricular paroxística em doentes portadores de pacemaker. Rev Port Cardiol 2014; 33:781-8. [DOI: 10.1016/j.repc.2014.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 05/19/2014] [Accepted: 06/06/2014] [Indexed: 11/17/2022] Open
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18
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Silva R, Pereira T, Martins V. Effectiveness of atrial antitachycardia pacing in the treatment of paroxysmal atrial fibrillation in patients with pacemakers. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2014.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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19
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Left atrial reverse remodeling and prevention of progression of atrial fibrillation with atrial resynchronization device therapy utilizing dual-site right atrial pacing in patients with atrial fibrillation refractory to antiarrhythmic drugs or catheter ablation. J Interv Card Electrophysiol 2014; 40:245-54. [DOI: 10.1007/s10840-014-9931-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 06/08/2014] [Indexed: 10/25/2022]
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20
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Watabe T, Abe H, Kohno R, Oginosawa Y, Hayashi K, Ohe H, Tamura M, Takeuchi M, Otsuji Y. Atrial pacing site and atrioventricular conduction in patients paced for sinus node disease. J Cardiovasc Electrophysiol 2014; 25:1224-31. [PMID: 24946835 DOI: 10.1111/jce.12476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 06/10/2014] [Accepted: 06/15/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Unnecessary ventricular pacing in sinus node disease (SND) must be avoided. To test the hypothesis that in SND, with or without 1st degree atrioventricular (AV) block, cumulative percent ventricular pacing (cum%VP) can be limited by low right atrial septal (LRAS) instead of right atrial appendage (RAA) pacing. METHODS We studied 102 dual-chamber pacemaker recipients with SND. The PQ interval on 12-lead electrocardiogram and the atrial paced to ventricular sensed interval (Ap-Vs) during LRAS and RAA pacing were measured and compared at implantation, 3 months and 1 year of follow-up. Group 1 included 62 patients with baseline PQ interval <200 milliseconds during LRAS (n = 28) versus RAA (n = 34) pacing. Group 2 included 40 patients with baseline PQ ≥200 milliseconds during LRAS (n = 20) versus RAA (n = 20) pacing. cum%VP were measured at 3 months and 1 year. RESULTS The characteristics and AV conduction properties were similar and the Ap-Vs interval was significantly shorter in the LRAS than in the RAA pacing group up to 1 year (193 ± 32 milliseconds vs. 220 ± 27 milliseconds in Group 1; P = 0.003, 222 ± 41 milliseconds vs. 281 ± 30 milliseconds in Group 2; P < 0.001). While cumulative percent atrial pacing was consistently similar, cum%VP was significantly smaller during LRAS than RAA pacing (1 ± 1% vs. 8 ± 18% in Group 1; P = 0.03, 7 ± 10% vs. 48 ± 38% in Group 2; P < 0.001). Similar observations were made with or without left atrial (LA) enlargement. CONCLUSION Compared with RAA, LRAS pacing showed shorter AV interval in SND patients with or without 1st degree AV block and LA enlargement. This beneficial effect persisted through 1-year follow-up, and decreased cum%VP significantly.
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Affiliation(s)
- Taichi Watabe
- Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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21
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Insertion of an active fixation lead in the inferior interatrial septum via a 9.0 Fr guiding catheter. J Arrhythm 2014. [DOI: 10.1016/j.joa.2013.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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22
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Pastore G, Aggio S, Baracca E, Fraccaro C, Picariello C, Roncon L, Corbucci G, Noventa F, Zanon F. Hisian area and right ventricular apical pacing differently affect left atrial function: an intra-patients evaluation. Europace 2014; 16:1033-9. [PMID: 24473501 DOI: 10.1093/europace/eut436] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Right ventricular apex (RVA) pacing has adverse effects on left atrial (LA) function and may contribute to atrial arrhythmias. The effects of Hisian area (HA) pacing on LA function are still lacking. The objective of this study is to assess the left ventricular (LV) electromechanical activation/relaxation, systolic (S), diastolic (D) phases, and their effects on LA function during pacing from HA and RVA. METHODS AND RESULTS Thirty-seven patients with normal cardiac function underwent permanent HA pacing. In all patients, a RVA backup lead was added. The patients first underwent 3 months of HA pacing, followed by 3 months of RVA pacing. After each 3-month period, we compared by echocardiography: S-D LV electromechanical delay (S-D EMD), S-D intra-LV dyssynchrony, LV S-D phases, and their function evaluated by myocardial performance index (MPI) and mitral annular tissue Doppler early diastolic velocity (E'), pulmonary arterial systolic pressure (PASP), and LA function (LA phasic volumes and their emptying fraction). Right ventricular apex compared with HA pacing increased S-D EMD (P < 0.001) and intra-LV dyssynchrony (P < 0.001). As a consequence, a significant longer LV isovolumetric contraction time (P < 0.001) and LV isovolumetric relaxation time (P = 0.05) were measured during RVA compared with HA pacing, whereas LV ejection time was shorter (P = 0.033). Moreover, HA pacing resulted in significantly better MPI (P = 0.039), higher value of E' (P = 0.049), and lower PASP (P < 0.001). Finally, RVA compared with HA pacing was associated to higher LA volumes pre-atrial contraction (P = 0.001) and minimal volume (P = 0.003) with reduction in passive emptying fraction (P < 0.001) and total emptying fraction (P = 0.005). CONCLUSION Hisian area compared with RVA pacing resulted in a more physiological LV electromechanical activation/relaxation and consequently better LA function.
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Affiliation(s)
- Gianni Pastore
- Department of Cardiology, Rovigo General Hospital, Via Tre Martiri, 140 45100 Rovigo, Italy
| | - Silvio Aggio
- Department of Cardiology, Rovigo General Hospital, Via Tre Martiri, 140 45100 Rovigo, Italy
| | - Enrico Baracca
- Department of Cardiology, Rovigo General Hospital, Via Tre Martiri, 140 45100 Rovigo, Italy
| | - Chiara Fraccaro
- Department of Cardiology, Rovigo General Hospital, Via Tre Martiri, 140 45100 Rovigo, Italy
| | - Claudio Picariello
- Department of Cardiology, Rovigo General Hospital, Via Tre Martiri, 140 45100 Rovigo, Italy
| | - Loris Roncon
- Department of Cardiology, Rovigo General Hospital, Via Tre Martiri, 140 45100 Rovigo, Italy
| | - Giorgio Corbucci
- Formerly Medtronic Bakken Research Center, 6229 Maastricht, The Netherlands
| | - Franco Noventa
- Departments of Clinical and Experimental Medicine, University of Padova School of Medicine, 35100 Padova, Italy
| | - Francesco Zanon
- Department of Cardiology, Rovigo General Hospital, Via Tre Martiri, 140 45100 Rovigo, Italy
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Haghjoo M, Mollazadeh R, Aslani A, Dastmalchi J, Mashreghi-Moghadam H, Heidari-Mokarar H, Vakili-Zarch A, Alizadeh A. Prediction of midterm performance of active-fixation leads using current of injury. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 37:231-6. [PMID: 23998792 DOI: 10.1111/pace.12262] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 07/10/2013] [Accepted: 07/18/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND There are only limited prospective data on the clinical relevance of current of injury (COI) as a predictor of the midterm performance of active-fixation leads. This study sought to investigate whether it is possible to predict the midterm performance of active-fixation leads using COI recorded at the time of implantation. METHODS AND RESULTS One hundred fifty patients (78 men; mean age, 63 ± 19 years) who received active-fixation pacing (n = 201) and defibrillator (n = 51) leads were studied. COI was measured from the intracardiac bipolar electrogram recorded at the time of lead implantation. The study outcome was good lead performance at 6 months, defined as P wave ≥ 1.5 mV, threshold <1.5 V for atrial lead, R-wave ≥ 5 mV, and threshold <1 V for ventricular lead. A total of 102 active-fixation atrial and 150 ventricular leads were implanted. During a 6-month follow-up, invasive intervention was required for seven atrial and seven ventricular leads. In multivariate analysis, COI was the only independent predictor of good outcome for the active-fixation atrial (odds ratio [OR]: 5.67, 95% confidence interval [CI]: 2.18-14.76, P = 0.001) and ventricular leads (OR: 3.99, 95% CI: 1.08-21.26, P = 0.002). Receiver-operating characteristic analysis identified ST-segment elevation ≥2.0 mV for the atrial leads (sensitivity, 75%; specificity, 89%) and ≥10.0 mV for the ventricular leads (sensitivity, 70%; specificity, 87%) as optimal cutoffs for good midterm performance. CONCLUSIONS Midterm performance of active-fixation leads is predictable using COI recorded at the time of lead implantation. A ST-segment elevation ≥2.0 mV in the atrial leads and ≥10.0 mV in the ventricular leads are recommended to improve the lead performance at 6 months.
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Affiliation(s)
- Majid Haghjoo
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Kronborg MB, Nielsen JC. Pacing in sinus node disease to prevent atrial fibrillation. Expert Rev Cardiovasc Ther 2013; 10:851-8. [PMID: 22908919 DOI: 10.1586/erc.12.79] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cardiac pacing is the only effective treatment for patients with symptomatic sinus node disease (SND). The majority of patients with SND have several risk factors associated with development of atrial fibrillation (AF) at the time of pacemaker implantation and are therefore considered a high-risk population. Patients with SND can be treated with any kind of commercially available pacemaker pacing in the atrium, the ventricle or both. Pacing in SND can therefore alter atrial and ventricular conduction and atrioventricular coupling. These mechanisms can prevent or contribute to initiation and maintenance of AF during pacing. Different pacemaker modalities and algorithms have been tested to reduce AF in patients with SND in recent decades. To prevent AF in this population, it seems to be important to mimic the optimal electromechanical function of the heart, especially to preserve an optimal atrioventricular coupling.
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Hohnloser SH, Healey JS, Gold MR, Israel CW, Yang S, van Gelder I, Capucci A, Lau CP, Fain E, Morillo CA, Ha A, Carlson M, Connolly SJ. Atrial overdrive pacing to prevent atrial fibrillation: Insights from ASSERT. Heart Rhythm 2012; 9:1667-73. [DOI: 10.1016/j.hrthm.2012.06.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Indexed: 12/22/2022]
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Huo Y, Holmqvist F, Carlson J, Gaspar T, Arya A, Wetzel U, Hindricks G, Piorkowski C, Bollmann A, Platonov PG. Effects of baseline P-wave duration and choice of atrial septal pacing site on shortening atrial activation time during pacing. Europace 2012; 14:1294-301. [PMID: 22436616 DOI: 10.1093/europace/eus060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Atrial septal pacing (ASP) has been shown to shorten P-wave duration (PWD) and reduce recurrence of atrial fibrillation (AF) in patients with bradyarrhythmias. However, variability of interatrial connections and atrial conduction properties may explain ASP's modest clinical benefit. The aim of this study was to assess the effect of ASP site on the duration of the paced P wave. METHODS AND RESULTS Atrial septal pacing at high atrial septum (HAS), posterior septum behind the fossa ovalis (PSFO), and coronary sinus ostium (CSo) was performed in 69 patients admitted for electrophysiological study (52 ± 16 years, 41 men). Twelve-lead electrocardiogram was recorded at baseline and during pacing, signal-averaged for analysis of PWD and P-wave shortening achieved by ASP (ΔPWD = paced PWD-baseline PWD). Baseline PWD was 128 ± 15 ms. The shortest PWD during pacing was achieved at CSo (112 ± 15 ms) followed by HAS (122 ± 14 ms, P< 0.001 vs. CSo) and PSFO (124 ± 21 ms, P< 0.001 vs. CSo). P wave was shortened during pacing in patients with baseline PWD of > 120 ms (n= 50), whereas those with PWD of ≤ 120 ms showed PWD lengthening (n= 19) when paced at HAS (8 ± 17 vs. -12 ± 15 ms, P< 0.001), PSFO (15 ± 17 vs. -12 ± 26 ms, P< 0.001) and CSo (6 ± 16 vs. -25 ± 18 ms, P< 0.001). CONCLUSION Pacing at CSo is associated with the shortest PWD. P-wave shortening is greatest in patients with baseline PWD of > 120 ms regardless of the pacing site. The results may have implications on the selection of candidates for ASP and the placement of the atrial septal lead, and warrant further evaluation in cases of permanent pacing in patients with paroxysmal AF.
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Affiliation(s)
- Yan Huo
- Department of Cardiology and Center for Integrative Electrocardiology at Lund University, Lund University, SE-221 85 Lund, Sweden.
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Kurita T. A Narrower Spacing of Electrodes and Atrial Septum Pacing. Circ J 2012; 76:582-3. [DOI: 10.1253/circj.cj-12-0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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28
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Minamiguchi H, Abe H, Kohno R, Oginosawa Y, Tamura M, Takeuchi M, Nagatomo T, Otsuji Y. Incidence and Characteristics of Far-Field R-Wave Sensing in Low Right Atrial Septum Pacing. Circ J 2012; 76:598-606. [DOI: 10.1253/circj.cj-11-0745] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Haruhiko Abe
- Division of Cardiology, University of Occupational and Environmental Health
- Department of Heart Rhythm Management, University of Occupational and Environmental Health
| | - Ritsuko Kohno
- Division of Cardiology, University of Occupational and Environmental Health
| | - Yasushi Oginosawa
- Division of Cardiology, University of Occupational and Environmental Health
| | - Masahito Tamura
- Division of Cardiology, University of Occupational and Environmental Health
| | - Masaaki Takeuchi
- Division of Cardiology, University of Occupational and Environmental Health
| | - Toshihisa Nagatomo
- Division of Cardiology, University of Occupational and Environmental Health
| | - Yutaka Otsuji
- Division of Cardiology, University of Occupational and Environmental Health
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Verlato R, Botto GL, Massa R, Amellone C, Perucca A, Bongiorni MG, Bertaglia E, Ziacchi V, Piacenti M, Del Rosso A, Russo G, Baccillieri MS, Turrini P, Corbucci G. Efficacy of low interatrial septum and right atrial appendage pacing for prevention of permanent atrial fibrillation in patients with sinus node disease: results from the electrophysiology-guided pacing site selection (EPASS) study. Circ Arrhythm Electrophysiol 2011; 4:844-50. [PMID: 21946316 DOI: 10.1161/circep.110.957126] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The role of pacing sites and atrial electrophysiology on the progression of atrial fibrillation (AF) to the permanent form in patients with sinus node dysfunction (SND) has never been investigated. The aim of the study was to investigate the relationship between atrial electrophysiology and the efficacy of atrial pacing at the low interatrial septum (IAS) or at the right atrial appendage (RAA) to prevent persistent/permanent AF in patients with SND. METHODS AND RESULTS The Electrophysiology-Guided Pacing Site Selection (EPASS) Study was a prospective, controlled, randomized study. Atrial refractoriness, basal and incremental conduction times from the RAA to the coronary sinus ostium were measured before implantation, and the difference (ΔCTos) was calculated. Patients with ΔCTos ≥ 50 ms (study group) and those with ΔCTos <50 ms (control group) were randomly assigned to RAA or IAS with algorithms for continuous atrial stimulation "on." The primary end point was time to development of permanent or persistent AF within a 2-year follow-up in the study group, IAS versus RAA. Data were analyzed by intention to treat. One hundred two patients (77 ± 7 years, 44 mol/L) were enrolled, 69 (68%) in the study group and 33 (32%) in the control group. Of these, 97 ended the study, respectively, randomly assigned: 29 IAS versus 36 RAA and 18 IAS versus 14 RAA. After a mean follow-up of 15 ± 7 (median, 17) months, 11 (16.6%) patients in the study group met the primary end point: 2 IAS versus 9 RAA (log rank=3.93, P=0.047). CONCLUSIONS In patients with SND and intra-atrial conduction delay, low IAS pacing was superior to RAA pacing in preventing progression to persistent or permanent AF. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00239226.
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Affiliation(s)
- Roberto Verlato
- Cardiology Department, General Hospital, Camposampiero, Italy.
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Modi S, Krahn A, Yee R. Current concepts in pacing 2010-2011: the right and wrong way to pace. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2011; 13:370-84. [PMID: 21710197 DOI: 10.1007/s11936-011-0137-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OPINION STATEMENT Over five decades have passed since the first permanent cardiac pacemakers were introduced into clinical medicine. Evolving technology and falling costs have demanded adaptation to clinical practice and implantation trends and, with the advent of evidenced-based medicine, the specific roles and benefits of individual pacemaker technologies have never been so carefully scrutinized. Pacing mode choice continues to be a subject of great controversy, and there are great regional variations in practice. We believe that single chamber atrial pacing use (AAI/R) has become an anachronism that should generally be abandoned (obviously with rare exceptional cases) and be replaced by dual chamber pacemakers (DDD/R) equipped with modern pacing algorithms that minimize patient exposure to ventricular pacing. Also, in patients with atrioventricular (AV) block, randomized clinical trials have failed to show improvement in clinically relevant outcomes such as mortality, stroke, and heart failure, particularly in the elderly, which has led some to advocate that DDD/R devices should never be offered to elderly AV block patients. However, we believe that the elderly, like the young, come in many "shapes and sizes" and individualized medicine compels us to consider each pacemaker candidate as unique. Implanting DDD/R devices in chronologically older, yet physiologically younger, patients is justifiable and good medical practice. Where right ventricular (RV) pacing is necessary and unavoidable, physicians should consider routinely placing RV leads on the RV mid- or outflow tract septum because these location are as good, if not better, for patients than the current practice of RV apical lead placement. In patients with AV block and asymptomatic yet moderate to severely depressed left ventricular systolic function, primary cardiac resynchronization therapy (CRT) should be strongly considered. Compelling clinical trial evidence does not yet exist to indicate that CRT should be the standard of care in patients with AV block and intact left ventricular systolic function. Right ventricular septal lead placement remains a reasonable option.
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Affiliation(s)
- Simon Modi
- Arrhythmia Service, London Health Sciences Centre, London, ON, Canada,
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Wang M, Siu CW, Lee KL, Yue WS, Yan GH, Lee S, Lau CP, Tse HF. Effects of right low atrial septal vs. right atrial appendage pacing on atrial mechanical function and dyssynchrony in patients with sinus node dysfunction and paroxysmal atrial fibrillation. Europace 2011; 13:1268-74. [DOI: 10.1093/europace/eur110] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Kay GN, Le Huezey JY, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann LS. 2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. Circulation 2011; 123:e269-367. [PMID: 21382897 DOI: 10.1161/cir.0b013e318214876d] [Citation(s) in RCA: 592] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Kay GN, Le Huezey JY, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann LS. 2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. J Am Coll Cardiol 2011; 57:e101-98. [PMID: 21392637 DOI: 10.1016/j.jacc.2010.09.013] [Citation(s) in RCA: 543] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Occhetta E, Bortnik M, Marino P. Future easy and physiological cardiac pacing. World J Cardiol 2011; 3:32-9. [PMID: 21286216 PMCID: PMC3030735 DOI: 10.4330/wjc.v3.i1.32] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 11/24/2010] [Accepted: 12/01/2010] [Indexed: 02/06/2023] Open
Abstract
The right atrial appendage (RAA) and right ventricular apex (RVA) have been widely considered as conventional sites for typical dual-chamber atrio-ventricular cardiac (DDD) pacing. Unfortunately conventional RAA pacing seems not to be able to prevent atrial fibrillation in DDD pacing for tachycardia-bradycardia syndrome, and the presence of a left bundle branch type of activation induced by RVA pacing can have negative effects. A new technology with active screw-in leads permits a more physiological atrial and right ventricular pacing. In this review, we highlight the positive effects of pacing of these new and easily selected sites. The septal atrial lead permits a shorter and more homogeneous atrial activation, allowing better prevention of paroxysmal atrial fibrillation. The para-Hisian pacing can be achieved in a simpler and more reliable way with respect to biventricular pacing and direct Hisian pacing. We await larger trials to consider this "easy and physiological pacing" as a first approach in patients who need a high frequency of pacing.
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Affiliation(s)
- Eraldo Occhetta
- Eraldo Occhetta, Miriam Bortnik, Paolo Marino, Division of Cardiology, "Maggiore della Carità" Hospital, University of Eastern Piedmont, 28100 Novara, Italy
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YASUOKA YOSHINORI, ABE HARUHIKO, UMEKAWA SEIKO, KATSUKI KEIKO, TANAKA NORIO, ARAKI RYO, IMANAKA TAKAHIRO, MATSUTERA RYO, MORISAWA DAISUKE, KITADA HIROKAZU, HATTORI SUSUMU, NODA YOSHIKI, ADACHI HIDENORI, SASAKI TATSUYA, MIYATAKE KUNIO. Interatrial Septum Pacing Decreases Atrial Dyssynchrony on Strain Rate Imaging Compared with Right Atrial Appendage Pacing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 34:370-6. [DOI: 10.1111/j.1540-8159.2010.02976.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zanon F, Svetlich C, Occhetta E, Catanzariti D, Cantù F, Padeletti L, Santini M, Senatore G, Comisso J, Varbaro A, Denaro A, Sagone A. Safety and performance of a system specifically designed for selective site pacing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 34:339-47. [PMID: 21070258 DOI: 10.1111/j.1540-8159.2010.02951.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION In the right ventricle, selective site pacing (SSP) has been shown to avoid detrimental hemodynamic effects induced by right ventricular apical pacing and, in the right atrium, to prevent the onset of atrial fibrillation and to slow down disease progression. The purpose of our multicenter observational study was to describe the use of a transvenous 4-French catheter-delivered lead for SSP in the clinical practice of a large number of centers. METHODS We enrolled 574 patients in whom an implantable device was indicated. In all patients, SSP was achieved by using the Select Secure System™ (Medtronic Inc., Minneapolis, MN, USA). RESULTS In 570 patients, the lead was successfully implanted. In 125 patients, atrial SSP was performed: in 75 (60%) the lead was placed in the interatrial septum, in 31 (25%) in the coronary sinus ostium, and in 19 (15%) in the Bachman bundle. Ventricular SSP was undertaken in 138 patients: in 105 (76%) the high septal right ventricular outflow tract (RVOT) position was paced, in seven (5%) the high free-wall RVOT, in 25 (18%) the low septal RVOT, and in one (1%) the low free-wall RVOT. In the remaining 307 patients, the His zone was paced: in 87 (28%) patients, direct His-bundle pacing and in 220 (72%) patients para-hisian pacing was achieved. Adequate pacing parameters and a lead-related complication rate of 2.6% were recorded during a follow-up of 20 ± 10 months. CONCLUSIONS Our results demonstrated that many sites, in the right atrium, in the right ventricle, and in His-bundle region, can be paced using the Select Secure System™.
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Affiliation(s)
- Francesco Zanon
- Division of Cardiology, Ospedale Santa Maria della Misericordia, Rovigo, Italy.
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Kurisu S, Inoue I, Kawagoe T, Ishihara M, Shimatani Y, Nakama Y, Maruhashi T, Kagawa E, Dai K, Matsushita J, Ikenaga H. Accidental connection between the atrial and ventricular stylets during a stimulation threshold test for pacemaker implantation. J Cardiovasc Med (Hagerstown) 2010; 11:190-2. [DOI: 10.2459/jcm.0b013e3283303d74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Dabrowska-Kugacka A, Lewicka-Nowak E, Rucinski P, Kozlowski D, Raczak G, Kutarski A. Single-Site Bachmann's Bundle Pacing Is Beneficial While Coronary Sinus Pacing Results in Echocardiographic Right Heart Pacemaker Syndrome in Brady-Tachycardia Patients. Circ J 2010; 74:1308-15. [DOI: 10.1253/circj.cj-09-0846] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Ewa Lewicka-Nowak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk
| | | | - Dariusz Kozlowski
- Department of Cardiology and Electrotherapy, Medical University of Gdansk
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk
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SPITZER STEFANG, WACKER PETRA, GAZAREK STEFFEN, MALINOWSKI KLAUS, SCHIBGILLA VOLKER. Primary Prevention of Atrial Fibrillation: Does the Atrial Lead Position Influence the Incidence of Atrial Arrhythmias in Patients with Sinus Node Dysfunction? Results from the PASTA Trial. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:1553-61. [DOI: 10.1111/j.1540-8159.2009.02544.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Klein M, Klein N, Pfeiffer D. [Atrial pacing for prevention of atrial fibrillation. Influence of septal atrial pacing, atrial overdrive and AV-delay-optimization on atrial fibrillation burden]. Herzschrittmacherther Elektrophysiol 2009; 20:148-153. [PMID: 19756816 DOI: 10.1007/s00399-009-0057-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Atrial overdrive and optimized interatrial conduction time can reduce atrial fibrillation (AF). Increased ventricular stimulation results in a higher incidence of atrial fibrillation. PATIENTS AND METHODS In 25 patients with paroxysmal AF, a dual-chamber pacemaker (Identity DR 5370, St. Jude Medical) was implanted. Atrial leads were placed randomly either septal (n=12) or conventional (n=13). Dynamic atrial overdrive (DAO) was activated and the AV delay was optimized according to Koglek's method. After 3, 6, 9, and 12 months automatic mode switch (AF burden) was analysed. RESULTS No difference in implantation parameters were observed between groups. Technical implantation parameters were in the normal range for both groups. After 12 months patients in the septal group had less AF burden (1% vs. 7%, p=0.06), and the total number of AF episodes was reduced. CONCLUSION Septal pacing is safe. In combination with DAO and AV delay optimization it may reduce the AF burden, which can be observed after 12 months.
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Affiliation(s)
- M Klein
- Abteilung Kardiologie/Angiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103 Leipzig, Deutschland.
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Dilaveris P, Stefanadis C. Current morphologic and vectorial aspects of P-wave analysis. J Electrocardiol 2009; 42:395-9. [DOI: 10.1016/j.jelectrocard.2009.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Indexed: 10/20/2022]
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LAU CHUPAK, WANG CHUNCHIEH, NGARMUKOS TACHAPONG, KIM YOUHO, KONG CHIWOON, OMAR RAZALI, SRIRATANASATHAVORN CHARN, MUNAWAR MUHAMMAD, KAM RUTH, LEE KATHYLF, LAU ELIZABETHOIYAN, TSE HUNGFAT. A Prospective Randomized Study to Assess the Efficacy of Rate and Site of Atrial Pacing on Long-Term Development of Atrial Fibrillation. J Cardiovasc Electrophysiol 2009; 20:1020-5. [DOI: 10.1111/j.1540-8167.2009.01484.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Although it has become traditional to place permanent pacemaker leads at the right ventricular apex and right atrial appendage, pacing from these locations poorly mimics normal physiology. A growing evidence base shows that right ventricular apical pacing results in ventricular dyssynchrony and various adverse effects. Provocative data from early trials suggest that pacing from alternate sites in the right ventricle--His bundle pacing, para-Hisian pacing, septal right ventricular outflow tract pacing, and right ventricular midseptal pacing--may lead to improved results. Similarly, early data suggest that right atrial pacing near Bachmann's bundle may lead to superior outcomes when compared with pacing from the right atrial appendage. Several large-scale, randomized clinical trials are now under way to establish the future role of selective site pacing.
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SCHUCHERT ANDREAS, REBESKI HANSPETER, PEIFFER THOMAS, BUB EBERHARD, DIETZ ARMIN, MORTENSEN KAI, ALI AYDIN MOHAMMED, CAMM JOHN, GAZAREK STEFFEN, MEINERTZ THOMAS. Effects of Continuous and Triggered Atrial Overdrive Pacing on Paroxysmal Atrial Fibrillation in Pacemaker Patients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:929-34. [DOI: 10.1111/j.1540-8159.2008.01118.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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de Voogt WG, van Hemel NM. Diagnostic tools for atrial tachyarrhythmias in implantable pacemakers: a review of technical options and pitfalls. Neth Heart J 2008; 16:201-10. [PMID: 18665205 PMCID: PMC2442663 DOI: 10.1007/bf03086146] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Correct pacemaker (PM) diagnosis of paroxysmal atrial tachyarrhythmias is crucial for their prevention and intervention with specific atrial pacing programmes. The PM mode switch to only ventricular pacing after detection of atrial tachyarrhythmias is often used as the parameter to quantify the 'burden' of atrial tachyarrhythmias. OBJECTIVES This review addresses potential errors in the detection and diagnosis of atrial tachyarrhythmias, sometimes resulting in incorrect mode switches. The interpretation of PM-stored data of patients with atrial tachyarrhythmias and the results of trials of pace prevention and intervention can be better appreciated with more insight into the technical options and pitfalls. RESULTS Literature and clinical experience demonstrate that the correctness of PM-derived diagnosis of atrial tachyarrhythmias depends on 1) the sensitivity setting to detect the onset and perpetuation of atrial tachyarrhythmias frequently characterised by variable and low-voltage signals, 2) the rejection of far-field R wave sensing by the atrial sense amplifier, 3) the facility for verification of mode switches by a high-quality intracardiac registration of the nonmodified atrial electrogram. The configuration of the atrial lead also contributes to the diagnostic performance of the PM. CONCLUSION Not only pacing algorithms and diverse technical PM features but also the atrial lead configuration are currently the limiting factors to the fully reliable, automated detection and diagnosis of atrial tachyarrhythmias. If these technical shortcomings can be improved, better signal processing will result. Then atrial pacing to prevent or suppress atrial tachyarrhythmias will be more justified. (Neth Heart J 2008;16:201-10.).
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Affiliation(s)
- W G de Voogt
- Department of Cardiology, St Lucas Andreas Hospital, Amsterdam, the Netherlands
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Gong D, Zhang Y, Cai B, Meng Q, Jiang S, Li X, Shan L, Liu Y, Qiao G, Lu Y, Yang B. Characterization and comparison of Na+, K+ and Ca2+ currents between myocytes from human atrial right appendage and atrial septum. Cell Physiol Biochem 2008; 21:385-94. [PMID: 18453746 DOI: 10.1159/000129631] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2008] [Indexed: 11/19/2022] Open
Abstract
Atrial pacing to reduce paroxysmal atrial fibrillation recurrences is performed in right atrial appendage (RAA) traditionally. However, recent studies indicate that atrial septal (AS) pacing produces better outcomes than the RAA pacing. The underlying mechanisms for this difference remained unclear. One possible explanation for the superiority of AS pacing over RAA pacing is that the two different regions have distinct electrophysiological properties. The study was to explore whether there indeed exist regional differences of electrical activities between RAA and AS, using whole-cell patch clamp techniques. The results showed that RAA cells had longer action potential duration, more negative resting potential and greater amplitude of action potential, whereas AS cells had more rapid depolarizing velocity. The sodium current was significantly smaller in RAA cells, whereas the calcium current was markedly smaller in AS cells. The transient outward K(+) current was similar in both regions. The ultrarapid delayed rectifier K(+) current was greater in RAA than that in AS cells. The inward rectifier K(+) current was similar at potentials more negative to -60 mV in both regions. The results indicate that RAA and AS of patients with rheumatic heart disease possess distinct electrophysiological properties. These differences provided a rational explanation for the different efficacies in treating atrial fibrillation by atrial pacing in RAA and AS regions.
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Affiliation(s)
- Dongmei Gong
- Department of Pharmacology, Harbin Medical University, Harbin, PR China
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Clinical application of pacemakers in atrial tachyarrhythmias. Neth Heart J 2008. [DOI: 10.1007/bf03086200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Nishii N, Kusano KF, Miyaji K, Hiramatsu S, Tada T, Murakami M, Banba K, Sakai Y, Nagase S, Nakamura K, Sakuragi S, Ohe T. Usefulness of a Long-Straight Sheath for Atrial Lead Insertion at the Right Atrial Septum. Circ J 2008; 72:262-7. [DOI: 10.1253/circj.72.262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Nobuhiro Nishii
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Kengo Fukushima Kusano
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Kohei Miyaji
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Shigeki Hiramatsu
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Takeshi Tada
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Masato Murakami
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Kimikazu Banba
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Yoshiaki Sakai
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Satoshi Nagase
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Satoru Sakuragi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Tohru Ohe
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
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Miki Y, Ishikawa T, Inoue N, Yamakawa Y, Kobayashi T, Matsushita K, Matsumoto K, Taima M, Kosuge M, Sumita S, Uchino K, Kimura K, Umemura S. Efficacy of Consistent Atrial Pacing Algorithm for Suppression of Atrial Arrhythmias in Patients With Sick Sinus Syndrome and Atrial Fibrillation. Int Heart J 2008; 49:273-80. [DOI: 10.1536/ihj.49.273] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Yuko Miki
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine
| | - Toshiyuki Ishikawa
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine
| | - Noriko Inoue
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine
| | - Youhei Yamakawa
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine
| | - Tsukasa Kobayashi
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine
| | - Kohei Matsushita
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine
| | - Katsumi Matsumoto
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine
| | - Minoru Taima
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine
| | - Masami Kosuge
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine
| | - Shinichi Sumita
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine
| | - Kazuaki Uchino
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine
| | - Kazuo Kimura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine
| | - Satoshi Umemura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine
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