Author + information
- Received September 28, 1995
- Revision received March 15, 1996
- Accepted May 3, 1996
- Published online September 1, 1996.
- Sanjeev Saksena, M.D., F.A.C.C.a,∗∗∗,1,
- Atul Prakash, M.D., M.R.C.P.a,∗,
- Michael Hill, PhD∗,
- Ryszard B. Krol, M.D.a,∗,
- Anand N. Munsif, M.D.a,∗,
- Philip P. Mathew, M.S.a,∗ and
- Rahul Mehra, PhD∗
- ↵∗∗Address for correspondence: Dr. Sanjeev Saksena, Cardiac Medicine and Electrophysiology, 55 Essex Street, Suite 3-2, Millburn, New Jersey 07041.
Objectives. We investigated 1) the feasibility, safety and efficacy of multisite right atrial pacing for prevention of atrial fibrillation (AF); and 2) the ability of atrial pacing in single- and dual-site modes to increase arrhythmia-free intervals in patients with drug-refractory AF.
Background. We recently developed and applied a novel technique of dual-site right atrial pacing in an unselected group of consecutive patients with AF requiring demand pacing. A prospective crossover study design was used to evaluate single- and dual-site right atrial pacing modes.
Methods. The frequency of AF during the 3 months before pacemaker implantation was analyzed. Consecutive consenting patients underwent insertion of two atrial leads and one ventricular lead with a DDDR pulse generator. Patients were placed in a dual-site pacing mode for the first 3 months and subsequently mode switched to single site pacing for 3 months. Mode switching was repeated at 6-month intervals thereafter.
Results. Atrial pacing resulted in a marked decline in AF recurrences (p < 0.001). During dual-site pacing with an optimal drug regimen, there was no AF recurrence in any patient compared with five recurrences in 12 patients during single-site pacing (p = 0.03). The mean (±SD) arrhythmia-free interval before pacing (14 ± 14 days) was prolonged with dual- (89 ± 7 days, p < 0.0001) and single-site pacing (76 ± 27 days, p < 0.0001). Symptomatic AF episodes showed a declining trend during dual- and single-site pacing compared with those during the preimplantation period (p = 0.10). Mean antiarrhythmic drug use for all classes declined from 4 ± 1.9 drugs before implantation to 1.5 ± 0.5 (p < 0.01) drugs after implantation. Twelve (80%) of 15 patients remained in atrial paced rhythm at 13 ± 3 months.
Conclusions. We conclude that multisite right atrial pacing is feasible, effective and safe for long-term application. Atrial pacing significantly prolongs arrhythmia-free intervals in patients with drug-refractory paroxysmal AF. Dual-site right atrial pacing may offer additional benefits and should be considered either as the primary mode or in patients unresponsive to single-site pacing.
- Received September 28, 1995.
- Revision received March 15, 1996.
- Accepted May 3, 1996.