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CLINICAL STUDY

Biatrial pacing for paroxysmal atrial fibrillation

A randomized prospective study into the suppression of paroxysmal atrial fibrillation using biatrial pacing

^* Maidstone General Hospital, Kent, United Kingdom

Manuscript received October 29, 2001; revised manuscript received April 11, 2002, accepted April 30, 2002.

^* Reprint requests and correspondence: Dr. Phyllis Holt, Dept. of Cardiology, Maidstone Hospital, Hermitage Lane, Barming, Kent ME16 9QQ, United Kingdom.
a.biffi{at}libero.it

OBJECTIVES: The purpose of this study was twofold: to assess whether biatrial pacing is superior to single-site pacing and capable of reducing the frequency of episodes of paroxysmal atrial fibrillation (PAF); and to compare pacing of the proximal coronary sinus (PCS) with the distal coronary sinus (DCS) and the effects of sequential or simultaneous biatrial pacing.

BACKGROUND: Interatrial conduction abnormalities have a role in the initiation of PAF. Biatrial pacing alters the site and timing of atrial depolarization and may benefit those with drug-resistant PAF.

METHODS: Nineteen patients with PAF who were intolerant of or refractory to medication were studied. All received right atrial (RA) and coronary sinus (CS) leads (either PCS or DCS). For three months the pacemaker was set in sensing mode only. Subsequently each patient completed three-month periods in random order in the following modes: RA pacing, CS pacing, biatrial pacing using inter-atrial delays of 15 and 70 ms.

RESULTS: Sixteen patients received a benefit from one or more pacing modes. The greatest reduction in PAF episodes was seen during biatrial pacing, especially with leads sited at the high right atrium (HRA) and distal CS (p = 0.0048). There was no difference for sequential or simultaneous pacing. Three patients derived no benefit.

CONCLUSIONS: In selected patients, biatrial pacing causes a significant decrease in atrial fibrillation episodes. Optimal lead sites were at the HRA and DCS. Simultaneous pacing conferred no benefit over sequential pacing.

Abbreviations and Acronyms   AF   atrial fibrillation   CS   coronary sinus   DCS   distal coronary sinus   HRA   high right atrium   PAF   paroxysmal atrial fibrillation   PCS   proximal coronary sinus   RA   right atrial/atrium   RAA   right atrial appendage

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