Why the study?
RAAp may increase atrial fibrillation risk compared with RASp, but implanting stylet-driven leads for RASp presents procedural challenges that limit clinical use.
Does right atrial septal pacing with lumenless leads reduce atrial fibrillation events and improve procedural outcomes compared to right atrial appendage pacing with stylet-driven leads in patients with sick sinus syndrome?
Does right atrial septal pacing with lumenless leads reduce atrial fibrillation events and improve procedural outcomes compared to right atrial appendage pacing with stylet-driven leads in patients with sick sinus syndrome?
Right atrial septal pacing using lumenless leads is safe, feasible, and reduces the incidence of postoperative and new-onset atrial fibrillation compared to traditional right atrial appendage pacing in patients with sick sinus syndrome.
RASp was associated with fewer AF events in sick sinus syndrome; hypothesis-generating and requires randomized confirmation before practice change.
Background Right atrial appendage pacing (RAAp) may increase the risk of atrial fibrillation (AF) compared to right atrial septal pacing (RASp). However, the implant of atrial septal stylet-driven lead (SDL) for RASp can present procedural challenges and limit its clinical application. We evaluated the long-term safety and feasibility of lumenless lead (LLL) with the delivery sheath for RASp and SDL for RAAp, and compared AF events between the RASp and RAAp in patients with sick sinus syndrome (SSS). Methods A total of 329 patients with SSS who underwent pacemaker implant were divided into two groups based on the site of atrial lead placement: the RASp group (n=162) with LLL, and the RAAp group (n=167) with SDL. Implant success rate, procedural time, P-wave characteristics, pacing parameters, complications and AF episodes were compared between the two groups. Results The success rate were similar for RASp and RAAp groups (98.8% vs. 97.6%, P >0.05). The lead implant time was significantly shorter in the RASp group (2.5±1.9 minutes vs. 10.3±2.9 minutes, P <0.05). During a mean follow-up of 36.4±20.5 months, the pacing parameters remained stable without serious complications. Additionally, the RASp group significantly reduced the incidence of the AF episodes (6.7% vs. 14.0%, P <0.05) and the new-onset AF (1.8% vs. 4.6%, P <0.05). Conclusions Long-term safety and feasibility of RASp with LLLs were comparable to those of RAAp patients with SDLs. The RASp reduced the incidence of postoperative AF episodes and new-onset AF. The RASp by delivery sheath implantation is a safe and effective method.
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Jin et al. (2025) studied this question.
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