Key result
High atrial septal pacing plus reactive ATP linked to ~44% less daily AF/AT time vs RAA pacing.
Why the study?
It was unknown whether AF burden varies by pacing site in patients with reactive atrial antitachycardia pacing.
Does high atrial septal pacing combined with reactive atrial antitachycardia pacing reduce atrial fibrillation burden in patients with sick sinus syndrome and paroxysmal AF compared to right atrial appendage pacing?
Cohort (n=109)
Does high atrial septal pacing combined with reactive atrial antitachycardia pacing reduce atrial fibrillation burden in patients with sick sinus syndrome and paroxysmal AF compared to right atrial appendage pacing?
Absolute Event Rate: 10% vs 18%
p-value: p=0.018
High atrial septal pacing combined with reactive atrial antitachycardia pacing significantly reduces atrial fibrillation burden compared to right atrial appendage pacing in patients with sick sinus syndrome.
May reduce AF burden in sick sinus syndrome; hypothesis-generating pending randomized confirmation.
Background It is unknown whether atrial fibrillation (AF) burden varies by pacing site in patients with reactive atrial antitachycardia pacing (rATP). We aimed to compare AF burden in patients with high atrial septal pacing (HASp) via delivery catheter and right atrial appendage pacing (RAAp) in patients with sick sinus syndrome (SSS). Methods We retrospectively identified 109 patients with a history of paroxysmal AF and SSS who had received dual‐chamber pacemaker implantation between January 2017 and December 2019, of whom 39 and 70 patients had HASp and RAAp, respectively. rATP was initiated after a 1‐month post‐implantation run‐in period. Results Patients with HASp had a significantly shorter P‐wave duration during atrial pacing than those with RAAp (99.3 ± 10.4 vs. 116.0 ± 14.3 ms, p < .001). During the 3‐year follow‐up period, the incidence of an AF lasting longer than 1 or 7 days was significantly lower (hazard ratio [HR], 0.45; p = .016; HR, 0.24; p = .004) than in those with RAAp. The median time of AF/AT per day in the follow‐up periods was significantly shorter in the HASp group than in the RAAp group (10 vs. 18 min/day, p = .018). Atrial lead division did not occur in the HASp group during the follow‐up period. Conclusions HASp via delivery catheter is as safe as RAAp, and HASp combined with rATP is effective for reducing AF burden in patients with SSS and paroxysmal AF.
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Sumiyoshi et al. (2023) conducted a cohort in Sick sinus syndrome and paroxysmal atrial fibrillation (n=109). High atrial septal pacing (HASp) vs. Right atrial appendage pacing (RAAp) was evaluated on Median time of AF/AT per day (min/day) (p=0.018). High atrial septal pacing combined with reactive atrial antitachycardia pacing significantly reduced median AF/AT time per day compared to right atrial appendage pacing (10 vs. 18 min/day, p=0.018).
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