A novel method of multisite atrial pacing, incorporating Bachmann's bundle area and coronary sinus ostium, for electrical atrial resynchronization in patients with recurrent atrial fibrillation

• Published in: Europace (London, England) England), 2007-09, Vol.9 (9), p.805-811
• Main Authors: Lewicka-Nowak, Ewa, Kutarski, Andrzej, D browska-Kugacka, Alicja, Ruci ski, Piotr, Zago d on, Pawe, Raczak, Grzegorz
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Arrhythmia Agents - therapeutic use; Atrial Fibrillation - complications; Atrial Fibrillation - diagnosis; Atrial Fibrillation - drug therapy; Atrial Fibrillation - prevention & control; Atrial Fibrillation - therapy; Cardiac Pacing, Artificial - methods; Catheter Ablation; Coronary Sinus - pathology; Electrocardiography - methods; Electrophysiologic Techniques, Cardiac - methods; Female; Follow-Up Studies; Heart Atria - pathology; Heart Conduction System; Humans; Male; Middle Aged; Pacemaker, Artificial; Time Factors
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/eum152

Aims The aim of the study was to assess efficacy and safety of a novel method of multisite atrial pacing, incorporating Bachmann's bundle (BB) and coronary sinus (CS) ostium pacing, which was implemented for the first time in atrial fibrillation (AF) patients with intra-atrial conduction delay. Methods and results This follow-up study included 97 patients with drug refractory symptomatic AF, sinus node dysfunction, sinus P-wave ≥ 120 ms, and normal atrioventricular conduction. Pacing efficacy was assessed on the basis of two main endpoints: successful rhythm control and the absence of documented or symptomatic AF. During the mean 2.3 ± 0.7 years of follow-up, the survival rate was 99%, pacing maintenance rate 97%, and the need for re-operation 5%. Rhythm control efficacy was 90%, and 14 patients had no evidence of recurrent AF. After implantation, the mean number of anti-arrhythmic drugs used (P < 0.0001), the need for cardioversion (P < 0.01), and the incidence (P < 0.0001) and duration (P < 0.001) of AF-related hospitalizations decreased. P-wave duration with multisite atrial pacing was shorter than during sinus rhythm, BB, and CS pacing (P < 0.0001). Conclusion A novel method of multisite atrial pacing is safe, provides effective long-term rhythm control, and decreases the necessity for adjunctive therapies in patients with refractory AF and intra-atrial conduction delay.