Efficacy of Low Interatrial Septum and Right Atrial Appendage Pacing for Prevention of Permanent Atrial Fibrillation in Patients With Sinus Node Disease

Author:

Verlato Roberto1,Botto Giovanni Luca1,Massa Riccardo1,Amellone Claudia1,Perucca Antonello1,Bongiorni Maria Grazia1,Bertaglia Emanuele1,Ziacchi Vigilio1,Piacenti Marcello1,Del Rosso Attilio1,Russo Giovanni1,Baccillieri Maria Stella1,Turrini Pietro1,Corbucci Giorgio1

Affiliation:

1. From the Cardiology Department, General Hospital, Camposampiero, Italy (PD) (R.V., M.S.B., P.T.); the Cardiology Department, S Anna Hospital, Como, Italy (G.L.B., G.R.); the Cardiology Department, Molinette Hospital, Torino, Italy (R.M., C.A.); the Cardiology Department, Presidi Ospedalieri Riuniti, Borgomanero, Italy (NO) (A.P.); the Cardiology Department, Cisanello Hospital, Pisa, Italy (M.G.B.); the Cardiology Department, Mirano Hospital, Mirano, Italy (VE) (E.B.); the Cardiology Department,...

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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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