S-2
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Interatrial septum pacing: a new
approach to prevent paroxysmal atrial fibrilation
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Luigi Padeletti, Maria Cristina
Porciani, Antonio Michelucci, Andrea Colella, Silvio Vena, Pietro Ticci, Gian Franco
Gensini.
Istituto di Clinica Medica Generale e Cardiologia, Universita degli Studi di Firenze,
Florence, Italy
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Abstract
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Background. There are a variety of
approaches to the prevention of atrial fibrillation with pacing. The purpose of
positioning the atrial lead on the septum is to activate both atria simultaneously from a
single pacing site.
Material and methods. Interatrial septum pacing was performed in 30
patients (19 males, 11 females, mean age 74 ± 9 years), 19 with brady-tachy syndrome and
recurrent episodes of atrial fibrillation, 6 with sinus bradycardia, 2 with second degree
AV block and 3 with carotid sinus hypersensitivity.
At implant interatrial conduction was measured by two multipolar electrocatheteres
placed in the atrial right lateral wall and in the distal coronary sinus respectively. In
all patients a steroid eluting screw-in lead was positioned in the interatrial septum
superiorly and posteriorly to the coronary sinus.
Results. At implant the mean p wave amplitude was 2.52 ± 1.34 mV,
the pacing threshold was 1.08 ± 0.62 V and the impedance was 1137 ± 619 Ohm. Interatrial
conduction delay was 97.7 ± 26 ms in sinus rhythm, 13 603 ± 35.8 ms during right atrial
pacing (p < 0.001) and 17.3 ± 13.3 ms during interatrial septum pacing (p < 0.001
vs sinus rhythm and p < 0.001 vs right atrial pacing). Mean p wave duration was 132 ±
23 ms in sinus rhythm and 84 ± 14 during interatrial septum pacing (p < 0.001). After
a mean follow-up of 6.5 ± 2.3 months (range 2-10 months) no patients without atrial
tachyarrhythmias before the implantation experienced atrial fibrillation. In the 19
patients with atrial fibrillation before implantation, we observed only 3 cases of
sympthomatic arrhythmias recurrence.
Conclusions. Interatrial septum pacing reduces significantly
interatrial conduction time and p wave duration; has no arrhythmic effect and might be
employed to prevent atrial fibrillation if wider prospective studies will confirm these
preliminary results.
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Key Words
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Atrial fibrillation
paroxysmal AF, interatrial conduction time, P wave duration, interatrial septum pacing, OA
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