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Atrial Pacing Site and Atrioventricular Conduction in Patients Paced for Sinus Node Disease
Author(s) -
WATABE TAICHI,
ABE HARUHIKO,
KOHNO RITSUKO,
OGINOSAWA YASUSHI,
HAYASHI KATSUHIDE,
OHE HISAHARU,
TAMURA MASAHITO,
TAKEUCHI MASAAKI,
OTSUJI YUTAKA
Publication year - 2014
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.12476
Subject(s) - medicine , cardiology , sick sinus syndrome , atrioventricular node , cardiac pacing , pr interval , atrioventricular block , heart rate , tachycardia , blood pressure
Atrial Pacing Site and AV Conduction Background Unnecessary ventricular pacing in sinus node disease (SND) must be avoided. To test the hypothesis that in SND, with or without 1st degree atrioventricular (AV) block, cumulative percent ventricular pacing (cum%VP) can be limited by low right atrial septal (LRAS) instead of right atrial appendage (RAA) pacing. Methods We studied 102 dual‐chamber pacemaker recipients with SND. The PQ interval on 12‐lead electrocardiogram and the atrial paced to ventricular sensed interval (Ap‐Vs) during LRAS and RAA pacing were measured and compared at implantation, 3 months and 1 year of follow‐up. Group 1 included 62 patients with baseline PQ interval <200 milliseconds during LRAS (n = 28) versus RAA (n = 34) pacing. Group 2 included 40 patients with baseline PQ ≥200 milliseconds during LRAS (n = 20) versus RAA (n = 20) pacing. cum%VP were measured at 3 months and 1 year. Results The characteristics and AV conduction properties were similar and the Ap‐Vs interval was significantly shorter in the LRAS than in the RAA pacing group up to 1 year (193 ± 32 milliseconds vs. 220 ± 27 milliseconds in Group 1; P = 0.003, 222 ± 41 milliseconds vs. 281 ± 30 milliseconds in Group 2; P < 0.001). While cumulative percent atrial pacing was consistently similar, cum%VP was significantly smaller during LRAS than RAA pacing (1 ± 1% vs. 8 ± 18% in Group 1; P = 0.03, 7 ± 10% vs. 48 ± 38% in Group 2; P < 0.001). Similar observations were made with or without left atrial (LA) enlargement. Conclusion Compared with RAA, LRAS pacing showed shorter AV interval in SND patients with or without 1st degree AV block and LA enlargement. This beneficial effect persisted through 1‐year follow‐up, and decreased cum%VP significantly.