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Published on: February 28, 2012
Is dual site better than single site atrial pacing in the prevention of atrial fibrillation?
J F Leclercq1, A De Sisti, P Fiorello
1Centre Chirurgical Val d'Or, Saint Cloud, France.
Insights
Dual site atrial pacing effectively reduces the incidence of paroxysmal and permanent atrial fibrillation (AF) in patients with prolonged P wave duration. Single site pacing showed no significant benefit in this patient group.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Long-term prevention of atrial fibrillation (AF) remains a challenge with single-site right atrial pacing.
- The efficacy of multisite atrial pacing in AF prevention is an area of ongoing research.
- Patient selection is crucial for optimizing pacing strategies in bradycardia and AF management.
Purpose of the Study:
- To compare the effectiveness of dual-site versus single-site atrial pacing in preventing atrial fibrillation.
- To evaluate the impact of pacing strategy on the incidence of paroxysmal and permanent AF.
- To identify patient subgroups that may benefit most from dual-site atrial pacing.
Main Methods:
- A comparative study involving 83 patients with DDD devices for sinus node dysfunction or bradycardia with documented AF.
- Dual-site atrial pacing (high right atrium-coronary sinus ostium) was compared to single-site pacing.
- Inclusion criteria for dual-site pacing included a sinus P wave duration ≥ 120 ms and recent paroxysmal AF episodes.
Main Results:
- Dual-site pacing significantly reduced the incidence of both paroxysmal AF (9/30 vs 15/21 patients, P < 0.01) and permanent AF (1/30 vs 8/21 patients, P < 0.01) compared to single-site pacing in patients with prolonged P waves (≥ 120 ms).
- No significant differences in AF incidence were observed between dual-site and single-site pacing in patients with normal P wave duration (< 120 ms).
- Patients receiving dual-site pacing had significantly longer sinus P wave durations, paced P wave durations, used more antiarrhythmic drugs, and had longer symptom duration.
Conclusions:
- Dual-site atrial pacing appears more effective than single-site pacing in improving the long-term prognosis of patients with prolonged P wave duration, reducing AF incidence.
- Single-site atrial pacing does not offer significant benefits in preventing AF in patients with normal P wave duration.
- These findings suggest that P wave duration is a key factor in selecting patients for dual-site atrial pacing to prevent atrial fibrillation.
Abstract:
Long-term prevention of atrial fibrillation is not constantly realized by single-site right atrial pacing, and the beneficial role of multisite atrial pacing is still being studied. Accordingly, we compared the effectiveness of dual site and single site atrial pacing in 83 patients (50 men, 33 women, aged 69 +/- 10 years), who received a DDD device for primary sinus node dysfunction or bradycardia with documented atrial fibrillation. Inclusion criteria for dual site pacing were a sinus P wave > or = 120 ms and at least two episodes of documented paroxysmal AF in the 6 months preceding implantation. Dual site atrial pacing (high right atrium-coronary sinus ostium) was performed in 30 cases, and was compared to 53 single site paced patients, 21 with a P wave > or = 120 ms and 32 with a P wave < 120 ms. The basic pacing rate was programmed at 68 +/- 4 beats/min (range 60-75 beats/min). Sinus P wave (133 +/- 20 vs 95 +/- 9 ms; P < 0.001), paced P wave (107 +/- 14 vs 99 +/- 15; P < 0.05), number of antiarrhythmic drugs used (2.4 +/- 1.2 vs 1.6 +/- 1.5, P < 0.05), and the duration of symptoms (8.1 +/- 4.5 vs 3.8 +/- 2.4 years; P < 0.001) were significantly higher in dual site patients. The other characteristics were similar. During the follow-up of 18 +/- 15 months (range 3-30 months), paroxysmal AF was documented in 33 patients. Among these patients, 13 developed permanent AF following at least one episode of paroxysmal AF. When comparing dual site patients and single site patients with a P wave duration > or = 120 ms, paroxysmal AF incidence was lower in the dual site group (9/30 patients vs 15/21 patients, P < 0.01), as well as permanent AF (1/30 patients vs 8/21 patients, P < 0.01). By contrast, comparison between dual site patients and the group of single site patients with a P wave duration < 120 ms did not evidence any significant differences in paroxysmal (9/30 patients vs 9/32 patients) and permanent (1/30 patients vs 4/32 patients) AF incidences. Dual site seems better able than single site atrial pacing to improve the natural history of patients with a prolonged P wave, reducing the incidence of paroxysmal and permanent AF. No benefit could be expected in patients with a normal P wave duration.
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