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Effects of baseline P-wave duration and choice of atrial septal pacing site on shortening atrial activation time during pacing.

Huo, Yan LU ; Holmqvist, Fredrik LU ; Carlson, Jonas LU ; Gaspar, Thomas; Arya, Arash; Wetzel, Ulrike; Hindricks, Gerhard; Piorkowski, Christopher; Bollmann, Andreas and Platonov, Pyotr LU (2012) In Europace 14(9). p.1294-1301
Abstract
BACKGROUND: Atrial septal pacing (ASP) has been shown to shorten P-wave duration (PWD) and reduce recurrence of atrial fibrillation (AF) in patients with bradyarrhythmias. However, variability of interatrial connections and atrial conduction properties may explain ASP's modest clinical benefit. The aim of this study was to assess the effect of ASP site on the duration of the paced P wave.



METHODS AND RESULTS: Atrial septal pacing at high atrial septum (HAS), posterior septum behind the fossa ovalis (PSFO), and coronary sinus ostium (CSo) was performed in 69 patients admitted for electrophysiological study (52 ± 16 years, 41 men). Twelve-lead electrocardiogram was recorded at baseline and during pacing, signal-averaged... (More)
BACKGROUND: Atrial septal pacing (ASP) has been shown to shorten P-wave duration (PWD) and reduce recurrence of atrial fibrillation (AF) in patients with bradyarrhythmias. However, variability of interatrial connections and atrial conduction properties may explain ASP's modest clinical benefit. The aim of this study was to assess the effect of ASP site on the duration of the paced P wave.



METHODS AND RESULTS: Atrial septal pacing at high atrial septum (HAS), posterior septum behind the fossa ovalis (PSFO), and coronary sinus ostium (CSo) was performed in 69 patients admitted for electrophysiological study (52 ± 16 years, 41 men). Twelve-lead electrocardiogram was recorded at baseline and during pacing, signal-averaged for analysis of PWD and P-wave shortening achieved by ASP (ΔPWD = paced PWD-baseline PWD). Baseline PWD was 128 ± 15 ms. The shortest PWD during pacing was achieved at CSo (112 ± 15 ms) followed by HAS (122 ± 14 ms, P< 0.001 vs. CSo) and PSFO (124 ± 21 ms, P< 0.001 vs. CSo). P wave was shortened during pacing in patients with baseline PWD of > 120 ms (n= 50), whereas those with PWD of ≤ 120 ms showed PWD lengthening (n= 19) when paced at HAS (8 ± 17 vs. -12 ± 15 ms, P< 0.001), PSFO (15 ± 17 vs. -12 ± 26 ms, P< 0.001) and CSo (6 ± 16 vs. -25 ± 18 ms, P< 0.001).



CONCLUSION: Pacing at CSo is associated with the shortest PWD. P-wave shortening is greatest in patients with baseline PWD of > 120 ms regardless of the pacing site. The results may have implications on the selection of candidates for ASP and the placement of the atrial septal lead, and warrant further evaluation in cases of permanent pacing in patients with paroxysmal AF. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Europace
volume
14
issue
9
pages
1294 - 1301
publisher
Oxford University Press
external identifiers
  • wos:000308234300009
  • pmid:22436616
  • scopus:84865451641
ISSN
1532-2092
DOI
10.1093/europace/eus060
language
English
LU publication?
yes
id
fb2906eb-dcf4-4636-8270-d33b5bce5613 (old id 2431565)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/22436616?dopt=Abstract
date added to LUP
2012-04-03 12:39:58
date last changed
2017-01-01 07:41:25
@article{fb2906eb-dcf4-4636-8270-d33b5bce5613,
  abstract     = {BACKGROUND: Atrial septal pacing (ASP) has been shown to shorten P-wave duration (PWD) and reduce recurrence of atrial fibrillation (AF) in patients with bradyarrhythmias. However, variability of interatrial connections and atrial conduction properties may explain ASP's modest clinical benefit. The aim of this study was to assess the effect of ASP site on the duration of the paced P wave.<br/><br>
<br/><br>
METHODS AND RESULTS: Atrial septal pacing at high atrial septum (HAS), posterior septum behind the fossa ovalis (PSFO), and coronary sinus ostium (CSo) was performed in 69 patients admitted for electrophysiological study (52 ± 16 years, 41 men). Twelve-lead electrocardiogram was recorded at baseline and during pacing, signal-averaged for analysis of PWD and P-wave shortening achieved by ASP (ΔPWD = paced PWD-baseline PWD). Baseline PWD was 128 ± 15 ms. The shortest PWD during pacing was achieved at CSo (112 ± 15 ms) followed by HAS (122 ± 14 ms, P&lt; 0.001 vs. CSo) and PSFO (124 ± 21 ms, P&lt; 0.001 vs. CSo). P wave was shortened during pacing in patients with baseline PWD of &gt; 120 ms (n= 50), whereas those with PWD of ≤ 120 ms showed PWD lengthening (n= 19) when paced at HAS (8 ± 17 vs. -12 ± 15 ms, P&lt; 0.001), PSFO (15 ± 17 vs. -12 ± 26 ms, P&lt; 0.001) and CSo (6 ± 16 vs. -25 ± 18 ms, P&lt; 0.001).<br/><br>
<br/><br>
CONCLUSION: Pacing at CSo is associated with the shortest PWD. P-wave shortening is greatest in patients with baseline PWD of &gt; 120 ms regardless of the pacing site. The results may have implications on the selection of candidates for ASP and the placement of the atrial septal lead, and warrant further evaluation in cases of permanent pacing in patients with paroxysmal AF.},
  author       = {Huo, Yan and Holmqvist, Fredrik and Carlson, Jonas and Gaspar, Thomas and Arya, Arash and Wetzel, Ulrike and Hindricks, Gerhard and Piorkowski, Christopher and Bollmann, Andreas and Platonov, Pyotr},
  issn         = {1532-2092},
  language     = {eng},
  number       = {9},
  pages        = {1294--1301},
  publisher    = {Oxford University Press},
  series       = {Europace},
  title        = {Effects of baseline P-wave duration and choice of atrial septal pacing site on shortening atrial activation time during pacing.},
  url          = {http://dx.doi.org/10.1093/europace/eus060},
  volume       = {14},
  year         = {2012},
}