Key result
EP study and EAM successfully guide pacemaker lead implantation in extensive atrial scar and standstill.
Why the study?
Atrial standstill is characterized by the absence of atrial activity, and identifying surviving atrial sites amenable for pacemaker lead implantation in extensive atrial fibrosis remains challenging.
Does electroanatomical mapping guide optimal pacemaker lead implantation in a patient with extensive atrial scar and atrial standstill?
Case Report (n=1)
Does electroanatomical mapping guide optimal pacemaker lead implantation in a patient with extensive atrial scar and atrial standstill?
Electroanatomical mapping can effectively guide pacemaker lead placement in patients with extensive atrial scarring and atrial standstill following complex atrial surgery.
May guide lead placement in atrial scar with standstill; hypothesis-generating and requires prospective validation.
Background: Atrial standstill is characterized by the absence of atrial activity. We report a case of a patient with extensive atrial fibrosis who underwent electrophysiologic study (EPS) and electroanatomical mapping (EAM) to identify surviving atrial sites amenable for pacemaker lead implantation. Case summary: A 72-year-old man with persistent atrial fibrillation (AF) and atrial functional mitral regurgitation/tricuspid regurgitation (MR/TR) underwent a Cox-Maze surgery, mitral and tricuspid valve repair, and biatrial plication. He was referred because of post-operative presyncope symptoms. Electrocardiography revealed atrial standstill and junctional rhythm (JR); however, EAM revealed that both atria were almost entirely scarred and isolated fibrillation in left pulmonary veins and coronary sinus. Junctional rhythm retrogradely conducted around an atrioventricular (AV) node and pacing at this area could conduct to the ventricle through the AV node. An atrial pacing lead was implanted at this area, which yielded a QRS wave similar to the own beat. However, the atrial lead voltage was quite low; hence, ventricular pacing lead was implanted to avoid a future occurrence of pacing failure. Discussion: This report demonstrates the benefits of EPS and EAM in informing optimal pacemaker implantation for patients with extensive scar in atrium.
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Ujiro et al. (2024) conducted a case report in Persistent atrial standstill following a Cox-Maze procedure (n=1). Electrophysiologic study (EPS) and electroanatomical mapping (EAM) guided pacemaker lead implantation was evaluated on Identification of surviving atrial sites amenable for pacemaker lead implantation. Electrophysiologic study and electroanatomical mapping successfully guided optimal pacemaker lead implantation in a patient with extensive atrial scar and persistent atrial standstill.
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