A novel method of multisite atrial pacing, incorporating Bachmann's bundle area and coronary sinus ostium, for electrical atrial resynchronization in patients with recurrent atrial fibrillation

Abstract

The aim of the study was to assess efficacy and safety of a novel method of multisite atrial pacing, incorporating Bachmann's bundle (BB) and coronary sinus (CS) ostium pacing, which was implemented for the first time in atrial fibrillation (AF) patients with intra-atrial conduction delay. This follow-up study included 97 patients with drug refractory symptomatic AF, sinus node dysfunction, sinus P-wave > or = 120 ms, and normal atrioventricular conduction. Pacing efficacy was assessed on the basis of two main endpoints: successful rhythm control and the absence of documented or symptomatic AF. During the mean 2.3 +/- 0.7 years of follow-up, the survival rate was 99%, pacing maintenance rate 97%, and the need for re-operation 5%. Rhythm control efficacy was 90%, and 14 patients had no evidence of recurrent AF. After implantation, the mean number of anti-arrhythmic drugs used (P < 0.0001), the need for cardioversion (P < 0.01), and the incidence (P < 0.0001) and duration (P < 0.001) of AF-related hospitalizations decreased. P-wave duration with multisite atrial pacing was shorter than during sinus rhythm, BB, and CS pacing (P < 0.0001). A novel method of multisite atrial pacing is safe, provides effective long-term rhythm control, and decreases the necessity for adjunctive therapies in patients with refractory AF and intra-atrial conduction delay.