Key result
Different right atrial lead positions did not significantly influence the incidence of atrial fibrillation at 24 months in patients with sinus node disease (rates ranged from 32% to 48%).
Why the study?
Does atrial lead position influence the incidence of atrial fibrillation in patients with sinus node dysfunction?
RCT (n=142)
Randomized to four groups
Does atrial lead position influence the incidence of atrial fibrillation in patients with sinus node dysfunction?
Alternative right atrial lead positions, including dual-site pacing, do not significantly reduce the incidence of atrial fibrillation compared to standard right atrial appendage pacing in patients with sinus node dysfunction.
Standard right atrial appendage pacing suffices; challenges rationale for alternative sites to prevent atrial fibrillation in sinus node disease.
INTRODUCTION: PASTA (pacing of the atria in sinus node disease) is a prospective and randomized trial, assessing the effect of different atrial lead positions on the atrial fibrillation (AF) incidence in patients with sinus node disease (SND). METHOD: The atrial lead position is randomized to: (a) free right atrial wall, (b) right atrial appendage (RAA), (c) coronary sinus ostium (CS-Os), or (d) dual site right atrial pacing (CS-Os + RAA). The pacemakers (Vitatron Selection 9000 or Prevent AF, Vitatron B.V., Arnhem, The Netherlands) are programmed in DDDR 70 mode and the total follow-up duration is 24 months. To describe the atrial rhythm state, pacemaker-derived data (arrhythmia counter) were assessed for AF episodes. AF was considered as evident, if the AF burden (time in AF related to follow-up interval) was >1% (i.e., 15 min/d). Follow-up data after 24 months were evaluated. RESULTS: The analysis evaluates 142 patients (77 male, 74.5 +/- 7.8 years). There was no statistical significant difference with respect to the occurrence of AF between the four groups after 24 months (A: 36%; B: 38%, C: 32%, D: 48%). The percentage of atrial/ventricular pacing was in A: 78/76%, in B: 84/81%, in C: 70/65%, and in D: 79/69%. These differences were not significant. CONCLUSION: The evaluation of the AF burden >1% and the total AF burden after 24 months did not show differences in the incidence of AF in patients with dual chamber pacemaker therapy for SND. We were not able to demonstrate a significant influence of right atrial lead position on the incidence of AF recurrence.
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Spitzer et al. (2009) conducted an RCT in Sinus node disease (n=142). Alternative right atrial lead positions (free wall, coronary sinus ostium, or dual site) vs. Right atrial appendage (RAA) lead position was evaluated on Incidence of atrial fibrillation (AF burden >1%). Different right atrial lead positions did not significantly influence the incidence of atrial fibrillation at 24 months in patients with sinus node disease (rates ranged from 32% to 48%).
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