Low interatrial septal pacing: A simple method

Abstract

BackgroundSinus node disease is associated with widespread structural and electrophysiological changes in the atria in addition to abnormalities at the sinus node. The atrial conduction disorder in patients with atrial pacing results in higher incidence of atrial fibrillation. Studies have shown that low interatrial septal pacing is superior to right atrial appendage pacing in preventing persistent or permanent atrial fibrillation in these patients. However, implantation of active fixation lead in low interatrial septal position is difficult and time consuming with conventional stylet, inhibiting application of this method in routine practice.MethodThe technique of implanting atrial pacing lead in low interatrial septum with hand-made stylet is presented in this study with emphasis on fluoroscopic landmark and electrocardiographic P wave pattern.ResultsThe results indicate acute and short-term success of low interatrial septal pacing in 10 patients out of 11 patients without major complications. Pacing parameters during implantation and 3 months post procedure were within normal limits.ConclusionThe initial favorable results of this study indicate low interatrial septal pacing with conventional active fixation lead using fluoroscopic landmark and electrocardiographic characteristics is feasible and reproducible with a simple technique.

Patient with sick sinus syndrome and implanted dual-chamber pacemaker with reduced P-wave duration following low interatrial septal pacing

“…After the DDD/R implantation the percentage of atrial pacing approached 100%, with almost none ventricular pacing. Due to the complete Bachmann bundle block, the atrial electrode was actively fixed in the lower part of the interatrial septum, in the region of the coronary sinus ostium, which was in concordance with the literature reports [12] . That approach, despite a nonphysiological direction of an atrial activation, yielded relatively short P-waves (paced P-wave: 179 ms vs intrinsic sinus P-wave: 237 ms).…”

“…Due to the complete Bachmann bundle block, the atrial electrode was actively fixed in the lower part of the interatrial septum, in the region of the coronary sinus ostium, which was in concordance with the literature reports. [ 12 ] That approach, despite a nonphysiological direction of an atrial activation, yielded relatively short P-waves (paced P-wave: 179 ms vs intrinsic sinus P-wave: 237 ms). It also contributed to a significantly shorter PR interval (paced PR: 204 ms vs sinus rhythm PR: 254 ms).…”