Giuseppe Stabile, Antonio De Simone,
Pietro Turco, Fabio Capasso, Ferdinando Petrazzuoli, Carmine De Matteis*, Pasquale
Golino°, Raffaele Rotunno#, Tommaso Di Napoli#.
Laboratorio di Elettrofisiologia, Casa di Cura San Michele, Maddaloni (CE),
*Divisione di Cardiologia, Ospedale Civile, San Felice a Cancello (CE),
°Divisione di Cardiologia, Ospedale Civile, Caserta, #Reparto di Cardiologia, Polla (SA),
Italy
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Backgrounds. Atrial pacing (AP) has
been reported to be effective in reducing recurrences of paroxysmal atrial fibrillation
(PAF). However the patients (pts) population in which this therapy might be used still
needs to be defined. Aim of this study was to analyze the electrophysiological
characteristics of pts in which AP has been effective.
Methods. Twenty pts with PAF (at least 2 episodes in the last 4
months) and sick sinus syndrome or conduction system disease underwent dual-chamber
pacemaker (PM) implant. All PM had rate-responsive and switch-mode functions. Before PM
implant all pts underwent electrophysiological study with determination of high right
atrium (HRA) effective refractory period (ERP), coronary sinus ostium (CSos) ERP and right
intra-atrial conduction time (interval between the atrial electrogram recorded in the HRA
and that recorded in the CSos) (CT). All PM were programmed in DDDR mode with a lower rate
of 75 beat per minute (bpm) and a high rate of 220 bpm minus pt age. In each pt we
analyzed the number of PAF recurrences at 4- and 8-month follow-up period.
Results. In the last 4 months before PM implant the mean number of
documented PAF was 4.35 ± 1.35. During the follow-up we observed a significant reduction
of PAF after 4 (1.35 ± 1.39, p < 0.001) and 8 (1.8 ± 1.7, p < 0.001) months. In 8
pts no recurrence of PAF was observed after 4 months and among them only one pt had a PAF
recurrence during the following 4 months. In this group of pts we observed a significantly
shorter CT as compared with the group of 12 pts with PAF recurrences during the first 4
month 38.5 ± 4.7 ms vs 45.4 ± 6.2 ms, p = 0.01). We did not observed any significant
difference in ERP between the two pts group, both in HRA and CSos.
Conclusions. Atrial pacing is effective in reducing PAF episodes,
however only few pts have no PAF recurrences. Patients with lower intra-atrial conduction
time are ideal candidates for this therapy.
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