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Atrial Septal Pacing to Resynchronize Atrial Contraction and Improve Atrial Transport Function

Accession number;05A0562159

Title;Atrial Septal Pacing to Resynchronize Atrial Contraction and Improve Atrial Transport Function

Author; MIYAZAKI HIDEKAZU (Jikei Univ. School Of Medicine, Tokyo) NOMA KENJI (Jikei Univ. School Of Medicine, Tokyo) DATE TARO (Jikei Univ. School Of Medicine, Tokyo) KOBAYASHI AKIMITSU (Jikei Univ. School Of Medicine, Tokyo) KOGA ATSUSHI (Jikei Univ. School Of Medicine, Tokyo) KUNO MAMORU (Jikei Univ. School Of Medicine, Tokyo) TAKEDA SATOSHI (Jikei Univ. School Of Medicine, Tokyo) IWANO KEIJI (Jikei Univ. School Of Medicine, Tokyo) SEKI SHINGO (Jikei Univ. School Of Medicine, Tokyo) INADA KEIICHI (Jikei Univ. School Of Medicine, Tokyo) MATSUO SEIICHIRO (Jikei Univ. School Of Medicine, Tokyo) MIYANAGA SATORU (Jikei Univ. School Of Medicine, Tokyo) ABE KUNIHIKO (Shonan Hospital, Kanagawa) YAMANE TEIICHI (Jikei Univ. School Of Medicine, Tokyo) SUGIMOTO KENICHI (Jikei Univ. School Of Medicine, Tokyo) MOCHIZUKI SEIBU (Jikei Univ. School Of Medicine, Tokyo)

Journal Title;J Cardiol

Journal Code:Y0264A

ISSN:0914-5087

VOL.45;NO.6;PAGE.239-246(2005)

Figure&Table&Reference;FIG.5, TBL.1, REF.16

Pub. Country;Japan

Language;English

Abstract;Objectives. Atrial septal pacing via a trans-septal breakthrough site within the right atrial septum can shorten global atrial activation time, resulting in significant reduction of recurrence of atrial fibrillation events. This study examined whether this pacing method will lead to resynchronization of atrial contraction and its benefit on hemodynamic function can be maintained for 24 months. Methods. Thirty patients with atrial fibrillation and delayed atrial conduction were enrolled (17 males, 13 females, mean age 73.+-.7 years). Trans-septal breakthrough site within the right atrial septum was identified through pacing from the dorsal left atrium. Continuous atrial septal pacing at the trans-septal breakthrough site was performed for 24 months. Time difference (TD) between right and left atrial contractions was measured during atrial septal pacing and sinus rhythm by pulse Doppler echocardiography of the trans-tricuspid (P-At) and mitral (P-Am) blood flows (TD=P-Am-P-At). Results. The atrial lead was screwed near the fossa ovalis in 29 of 30 patients. Atrial septal pacing yielded significantly shorter P wave duration (101.9.+-.10.4 vs 139.6.+-.14.7 msec, p<0.001), leading to significant reduction of TD in atrial contraction (-8.8.+-.10.0 vs 29.8.+-.13.6 msec, p<0.001) as compared to sinus rhythm. Both shorter P wave duration and reduced TD during atrial septal pacing remained statistically significant during the follow-up period as compared to sinus rhythm. Both left atrial diameter and A to E ratio of filling waves at mitral valve were significantly decreased at 12 months and remained decreased at 24 months. Conclusions. Atrial septal pacing at the trans-septal breakthrough site can resynchronize atrial contraction and results in improved hemodynamic effects during 24 months of follow-up. (author abst.)

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