Physiological pacing using septal atrial leads and para-Hisian pacing may offer better prevention of paroxysmal atrial fibrillation and more reliable activation than conventional pacing sites.
Does septal atrial and para-Hisian pacing improve physiological activation and prevent atrial fibrillation compared to conventional RAA and RVA pacing in patients requiring high-frequency pacing?
Alternative pacing sites such as the atrial septum and para-Hisian region may offer more physiological activation and better prevention of atrial fibrillation than conventional right atrial appendage and right ventricular apex pacing.
The right atrial appendage (RAA) and right ventricular apex (RVA) have been widely considered as conventional sites for typical dual-chamber atrio-ventricular cardiac (DDD) pacing. Unfortunately conventional RAA pacing seems not to be able to prevent atrial fibrillation in DDD pacing for tachycardia-bradycardia syndrome, and the presence of a left bundle branch type of activation induced by RVA pacing can have negative effects. A new technology with active screw-in leads permits a more physiological atrial and right ventricular pacing. In this review, we highlight the positive effects of pacing of these new and easily selected sites. The septal atrial lead permits a shorter and more homogeneous atrial activation, allowing better prevention of paroxysmal atrial fibrillation. The para-Hisian pacing can be achieved in a simpler and more reliable way with respect to biventricular pacing and direct Hisian pacing. We await larger trials to consider this "easy and physiological pacing" as a first approach in patients who need a high frequency of pacing.
Eraldo Occhetta (Sat,) conducted a review in Tachycardia-bradycardia syndrome / need for high frequency pacing. Septal atrial lead and para-Hisian pacing vs. Conventional right atrial appendage and right ventricular apex pacing was evaluated. Physiological pacing using septal atrial leads and para-Hisian pacing may offer better prevention of paroxysmal atrial fibrillation and more reliable activation than conventional pacing sites.
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