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Interatrial septum pacing avoids the adverse effect of interatrial delay in biventricular pacing: an echo-Doppler
Maria Cristina Porciani1, Alessandra Sabini, Andrea Colella
1Institute of Internal Medicine and Cardiology, University of Florence, Italy. c.porciani@dfc.unifi.it
Insights
Interatrial delay (IAD) causes uneven atrioventricular delays during biventricular pacing (BVP). Interatrial septum pacing (IASP) with BVP corrects this, improving cardiac resynchronization in dilated cardiomyopathy patients.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Medical Devices
Background:
- Biventricular pacing (BVP) improves hemodynamics in dilated cardiomyopathy (DCM) by reducing interventricular delay (IVD).
- Interatrial delay (IAD) and IVD often coexist in DCM patients.
- The interplay between IAD and programmed atrioventricular delays can create hemodynamic imbalances.
Purpose of the Study:
- To investigate if IVD reduction due to IAD causes an imbalance between programmed and effective atrioventricular delays.
- To determine if interatrial septum pacing (IASP) combined with BVP can overcome this adverse effect.
Main Methods:
- Echocardiography-Doppler was used to measure IAD, IVD, and left/right mechanical atrioventricular delays (L-RMAVD) in 29 patients undergoing BVP.
- Patients were divided into two groups based on atrial lead placement: right atrial appendage (Group A) and interatrial septum (Group B).
Main Results:
- In Group A (right atrial appendage lead), L-RMAVD was significantly shorter than R-RMAVD, and IAD was significantly longer than IVD.
- In Group B (interatrial septum lead), no significant differences were found between L-RMAVD and R-RMAVD, or between IAD and IVD.
Conclusions:
- Interatrial delay (IAD) leads to differential left and right atrioventricular activation sequences during BVP.
- Interatrial septum pacing (IASP) concurrent with BVP effectively resynchronizes both atria and ventricles, mitigating adverse effects.
Aims:
Biventricular pacing (BVP) can improve haemodynamics in patients with dilated cardiomyopathy (DCM) and left bundle branch block by reducing interventricular delay (IVD). Since in DCM interatrial delay (IAD) and IVD frequently coexist, the aim of this study was to test the hypothesis that IVD reduction associated with IAD produces an imbalance between the programmed right atrioventricular (AV) delay and the effective AV delay on the left, and that interatrial septum pacing (IASP) combined with BVP overcomes this adverse effect.
Methods And Results:
IAD, IVD, left and right mechanical atrioventricular delay (L-RMAVD) were measured by echo-Doppler in 29 patients with BVP: 17 patients (Group A) had the atrial lead in the right atrial appendage, 12 patients (Group B) who experienced paroxysmal atrial fibrillation had the atrial lead on the interatrial septum. In Group A, LMAVD was significantly shorter than RMAVD (172 +/- 24 vs 207 +/- 24 ms, P<0.002), IAD was significantly longer than IVD (52 +/- 24 vs 21 +/- 18 ms, P<0.0001). In Group B, no differences were observed between LMAVD and RMAVD (187 +/- 32 vs 185 +/- 28 ms, NS), and between IAD and IVD (11 +/- 12 vs 13 +/- 16 ms, NS).
Conclusions:
IAD produces different left and right atrioventricular sequences in BVP. IASP combined with BVP, by resynchronizing both atria and ventricles, is able to avoid this adverse effect.