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CLINICAL STUDY

Interatrial septum pacing guided bythree-dimensional intracardiac echocardiography

^* Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands

Manuscript received March 12, 2002; revised manuscript received August 2, 2002, accepted August 19, 2002.

^* Reprint requests and correspondence: Dr. Tamas Szili-Torok, Department of Clinical Electrophysiology, Thoraxcentre, Rotterdam, Dr Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
szili{at}card.azr.nl

OBJECTIVES: Currently, the interatrial septum (IAS) pacing site is indirectly selected by fluoroscopy and P-wave analysis. The aim of the present study was to develop a novel approach for IAS pacing using intracardiac echocardiography (ICE).

BACKGROUND: Interatrial septum pacing may be beneficial for the prevention of paroxysmal atrial fibrillation.

METHODS: Cross-sectional images are acquired during a pull-back of the ICE transducer from the superior vena cava into the inferior vena cava by an electrocardiogram- and respiration-gated technique. Both atria are then reconstructed using three-dimensional (3D) imaging. Using an "en face" view of the IAS, the desired pacing site is selected. Following lead placement and electrical testing, another 3D reconstruction is performed to verify the final lead position.

RESULTS: Twelve patients were included in this study. The IAS pacing was achieved in all patients including six suprafossal (SF) and six infrafossal (IF) lead locations all confirmed by 3D imaging. The mean duration times of atrial lead implantation and fluoroscopy were 70 ± 48.9 min and 23.7 ± 20.6 min, respectively. The IAS pacing resulted in a significant reduction of the P-wave duration as compared to sinus rhythm (98.9 ± 19.3 ms vs. 141.3 ± 8.6 ms; p < 0.002). The SF pacing showed a greater reduction of the P-wave duration than IF pacing (59.4 ± 6.6 ms vs. 30.2 ± 13.6 ms; p < 0.004).

CONCLUSIONS: Three-dimensional ICE is a feasible tool for guiding IAS pacing.

Abbreviations and Acronyms   ECG   electrocardiogram   FO   fossa ovalis   IAS   interatrial septum   ICE   intracardiac echocardiography   IF   infrafossal   IVC   inferior vena cava   SF   suprafossal   SVC   superior vena cava   3D   three-dimensional

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