Elsevier

American Heart Journal

Volume 142, Issue 6, December 2001, Pages 1047-1055
American Heart Journal

Electrophysiology
Randomized crossover comparison of right atrial appendage pacing versus interatrial septum pacing for prevention of paroxysmal atrial fibrillation in patients with sinus bradycardia

https://doi.org/10.1067/mhj.2001.119373Get rights and content

Abstract

Background New atrial pacing techniques and overdrive pacing algorithms have been introduced to prevent atrial fibrillation. This study was designed to test the hypotheses that (1) interatrial septum pacing (IASP) at the triangle of Koch would be more effective than right atrial appendage pacing (RAAP) in preventing paroxysmal atrial fibrillation (PAF) in patients with sinus bradycardia and (2) an algorithm (CAP) designed to achieve constant atrial capture would increase the efficacy of rate-responsive atrial pacing. Methods We studied 46 patients with PAF and sinus bradycardia implanted with a DDD(R) (Medtronic Thera) pacemaker. Twenty-four patients (6.0 ± 10.1 PAF episodes/month within 3 months before study) were randomized to RAAP and 22 patients (5.4 ± 7.1, not significant) to IASP. Within each arm 2 randomized crossover periods of CAP-OFF and CAP-ON function were programed. Results The PAF episodes per month significantly decreased in the RAAP (CAP-OFF: 2.1 ± 4.2, P < .05; CAP-ON: 1.9 ± 3.8, P < .05) and in the IASP group (CAP-OFF: 0.2 ± 0.5, P < .05; CAP-ON: 0.2 ± 0.5, P < .05). Values were significantly lower in the IASP group than in the RAAP group in both CAP-OFF (0.2 ± 0.5 vs 2.1 ± 4.2, P < .05) and CAP-ON (0.2 ± 0.5 vs 1.9 ± 3.8, P < .05) conditions. PAF burden was significantly lower in the IASP than in the RAAP group in CAP-OFF (47 ± 84 min/d vs 140 ± 217, P < .05) and in CAP-ON (41 ± 72 vs 193 ± 266, P < .05) conditions. No differences were observed within each arm in PAF burden between the 2 crossover CAP programing periods. Conclusions Rate-adaptive IASP at the triangle of Koch is more effective than RAAP in preventing PAF in patients with sinus bradycardia. In our sample of patients no additional clinical benefit is furnished by the CAP algorithm. (Am Heart J 2001;142:1047-55.)

Section snippets

Study population

Forty-six patients (18 male, 28 female, mean age 74 ± 12 years) with a history of sinus bradycardia and PAF who had had at least 2 episodes per month of symptomatic PAF within 3 months before study were enrolled. At least one of these episodes was documented electrocardiographically. No patients had atrial linear or atrioventricular node ablation before or during the trial. The study was approved by the institutional review board, and witnessed informed consent was obtained from each patient.

Study protocol

Study population

Twenty-two patients (11 male, 11 female, 76 ± 6 years old) were randomized to the IASP group and 24 (7 male, 17 female, 74 ± 10 years old) to the RAAP group. The clinical characteristics of the 2 groups were similar and are shown in Table I.

. Characteristics of study population

Empty CellIASP (n = 22)RAAP (n = 24)
Age (y)76 ± 674 ± 10
Female (%)11 (50)17 (71)
Symptomatic PAF episodes/mo5.4 ± 7.16.0 ± 10.1
Heart disease
 None5 (23)7 (29)
 Hypertension9 (41)6 (25)
 Coronary artery disease10 (45)12 (50)
 Valvular heart

Pacing and prevention of AF

Becker et al16 studied the effects of single-, dual-, triple-, and quadruple-site atrial pacing on atrial activation and refractoriness in normal canine hearts. Single-site septal, triple-site (2 in the right atrium and 1 in the left atrium) and quadruple-site (2 in the right atrium and 2 in the left atrium) pacing was similar and was more efficient than biatrial and dual-site right atrial pacing in minimizing activation times and local recovery intervals.

Yu et al17 showed that in patients with

References (33)

  • FD Murgatroyd et al.

    A new pacing algorithm for overdrive suppression of atrial fibrillation: Chorus Multicentre Study Group

    Pacing Clin Electrophysiol

    (1994)
  • R Ricci et al.

    Consistent atrial pacing: can this new algorithm suppress recurrent paroxysmal atrial fibrillation? [abstract]

    Pacing Clin Electrophysiol

    (1997)
  • C Daubert et al.

    Atrial tachyarrhythmias associated with high degree interatrial conduction block: prevention by permanent atrial resynchronisations

    Eur J Card Pacing Electrophysiol

    (1994)
  • SJ Bailin et al.

    Prevention of chronic atrial fibrillation by pacing at Bachmann’s bundle: results of a randomized prospective multicenter study [abstract]

    Circulation

    (1999)
  • L Padeletti et al.

    Interatrial septum pacing: a new approach to prevent recurrent atrial fibrillation

    J Interv Card Electrophysiol

    (1999)
  • K Seidl et al.

    Is the high rate atrial episode diagnostic feature reliable in detecting paroxysmal episodes of atrial tachyarrhythmias?

    Pacing Clin Electrophysiol

    (1998)
  • Cited by (147)

    • 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

      2019, Heart Rhythm
      Citation Excerpt :

      All the studies were RCT with appropriate study methodology. Twelve studies were crossover trials,8,9,12,14–20,23 whereas 13 studies were parallel trials.3–7,10,11,13,21,22 Most trials were single-blinded, 1 was double-blinded,10 and 9 studies did not mention the blinding method.

    View all citing articles on Scopus

    Reprint requests: Luigi Padeletti, MD, Institute of Internal Medicine and Cardiology, University of Florence, Viale Morgagni 85, 50134 Florence, Italy. E-mail: [email protected]

    View full text