Key result
Low interatrial septum pacing was superior to right atrial appendage pacing for preventing persistent or permanent AF in patients with sinus node dysfunction (6.9% vs 25.0%; P=0.047).
Why the study?
Does low interatrial septum pacing prevent progression to persistent or permanent atrial fibrillation in patients with sinus node dysfunction compared to right atrial appendage pacing?
RCT (n=102)
randomly assigned
Does low interatrial septum pacing prevent progression to persistent or permanent atrial fibrillation in patients with sinus node dysfunction compared to right atrial appendage pacing?
Absolute Event Rate: 6.9% vs 25%
p-value: p=0.047
In patients with sinus node dysfunction and intra-atrial conduction delay, low interatrial septum pacing significantly reduces progression to persistent or permanent atrial fibrillation compared to standard right atrial appendage pacing.
May support low interatrial septum pacing in sinus node dysfunction; extends randomized evidence for atrial pacing site selection.
BACKGROUND: The role of pacing sites and atrial electrophysiology on the progression of atrial fibrillation (AF) to the permanent form in patients with sinus node dysfunction (SND) has never been investigated. The aim of the study was to investigate the relationship between atrial electrophysiology and the efficacy of atrial pacing at the low interatrial septum (IAS) or at the right atrial appendage (RAA) to prevent persistent/permanent AF in patients with SND. METHODS AND RESULTS: The Electrophysiology-Guided Pacing Site Selection (EPASS) Study was a prospective, controlled, randomized study. Atrial refractoriness, basal and incremental conduction times from the RAA to the coronary sinus ostium were measured before implantation, and the difference (ΔCTos) was calculated. Patients with ΔCTos ≥ 50 ms (study group) and those with ΔCTos <50 ms (control group) were randomly assigned to RAA or IAS with algorithms for continuous atrial stimulation "on." The primary end point was time to development of permanent or persistent AF within a 2-year follow-up in the study group, IAS versus RAA. Data were analyzed by intention to treat. One hundred two patients (77 ± 7 years, 44 mol/L) were enrolled, 69 (68%) in the study group and 33 (32%) in the control group. Of these, 97 ended the study, respectively, randomly assigned: 29 IAS versus 36 RAA and 18 IAS versus 14 RAA. After a mean follow-up of 15 ± 7 (median, 17) months, 11 (16.6%) patients in the study group met the primary end point: 2 IAS versus 9 RAA (log rank=3.93, P=0.047). CONCLUSIONS: In patients with SND and intra-atrial conduction delay, low IAS pacing was superior to RAA pacing in preventing progression to persistent or permanent AF. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00239226.
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Verlato et al. (2011) conducted an RCT in Sinus node dysfunction (n=102). Low interatrial septum (IAS) pacing vs. Right atrial appendage (RAA) pacing was evaluated on time to development of permanent or persistent AF within a 2-year follow-up in the study group (p=0.047). Low interatrial septum pacing was superior to right atrial appendage pacing for preventing persistent or permanent AF in patients with sinus node dysfunction (6.9% vs 25.0%; P=0.047).
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