Key result
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.
Why the study?
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?
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.
May inform site selection in high-frequency pacing; leaves open confirmation by randomized trials.
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.
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Eraldo Occhetta (2011) 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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