Cardiovascular medicine
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
D H Bennett
Regional Cardiac
Centre, Wythenshawe Hospital, Manchester M23 9LT, UK
Correspondence to: Dr Bennett
Accepted 23 March 2000
OBJECTIVE
To compare the acute
effects of right atrial appendage, atrial septal, coronary sinus os,
and dual site pacing on the duration of atrial activation.
METHODS20 patients with a variety of
cardiac conditions underwent an intracardiac electrophysiological
study. Electrograms were recorded from the right atrial appendage and
at multiple sites within the coronary sinus. The duration of atrial
activation was measured during pacing at the right atrial appendage,
atrial septum, and coronary sinus os, and also during dual site stimulation.
RESULTSThe duration of atrial
activation with atrial appendage pacing was notably longer
(p < 0.001) than with dual site, septal, or coronary sinus os
pacing, but there were no significant differences in atrial activation
times between these latter three pacing modes. When stimulating the
atria at a cycle length of 500 ms, the mean (SD) duration of atrial
activation was 145 (37) ms for right atrial appendage pacing, 93 (26) ms for dual site pacing, 96 (28) ms for septal pacing, and 98 (28) ms for coronary sinus os pacing.
CONCLUSIONSAssuming that the
duration of atrial activation is an important determinant of
predisposition to paroxysmal atrial fibrillation, atrial septal pacing
or coronary sinus os pacing would appear to offer the same advantage as
dual site pacing without the additional complexities associated with
the latter pacing mode.
Keywords: atrial septal pacing; dual site pacing; atrial activation; atrial fibrillation
© 2000 by Heart
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