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

The Alternative Atrial Pacing Sites

“…The coronary sinus and biatrial location was combined with more dislodgements and a significantly longer implantation procedure time. Taking (23,59) have obtained different results in comparison to those previously mentioned. The studied hypothesis was the impact of different atrial pacing sites on the secondary prevention of atrial fibrillation.…”

“…The shortening of the depolarization of both atria and the subsequent shortening of P wave duration related to the optimization of pacing site does not always carry the measurable benefits -both hemodynamic and antiarrhythmic ones. In a number of small studies it was shown that the benefit of such a stimulation was observed only in patients with initially larger interatrial conduction disturbances and/or paroxysmal atrial fibrillation because of the fact that none of the atrial pacing settings will be better than the own physiological conduction in the sinus rhythm and the non-disturbed conductive system (13,23). In one randomized trial of Hermida et al the benefits of low septum pacing were shown only in the group of patients with paroxysm of atrial fibrillation during three months before pacemaker implantation (24).…”

Clinical application of pacemakers in atrial tachyarrhythmias

“…12 Atrial septum pacing promoting a short activation time, either by Bachman bundle pacing or by low atrial septum pacing, has been explored in short-term trials with few patients involved, and looked promising. 9,10 However larger trials were unable to confirm the initially positive results. 13,14 This difference can be explained by the 'mixed bag' of patients included in the larger trials who mostly had a short P-wave duration.…”

Implanted Devices and Atrial Fibrillation

“…Another alternative site for atrial pacing is the low interatrial septum near the triangle of Koch, where most of the connections between right and left atria have been discovered. Pacing at the low interatrial septum has been associated with a reduced AF burden and again, with shorter P-wave duration [43]. These alternative pacing sites obviously require active-fixation leads, but appear to be as stable and safe as conventional, passive-fixation, atrial appendage leads.…”