Effect of atrial septal pacing on P-wave duration dispersion and atrial late potentials in patients with paroxysmal atrial fibrillation

Abstract

Atrial fibrillation (AF) is a common type of arrhythmia and its incidence increases with aging. Long-term antiarrhythmic drug therapy was usually used for the maintenance of sinus rhythm in patients with paroxysmal AF. However, many patients with paroxysmal AF experience AF recurrence in the long term. 1 Fuchs T. Podrid P.J. Pharmacologic therapy for revision of atrial fibrillation and maintenance of sinus rhythm. in: Falk R.H. Podrid P.J. Atrial Fibrillation: Mechanism and Management. Raven Press, New York1992: 253-254 Google Scholar Nonpharmacologic therapies have been investigated, including maze surgery, internal defibrillators, catheter ablation, and pacemakers. 2 Barold S.S. The role of cardiac pacing in the prevention of atrial fibrillation. Cardiol Rev. 1992; 4: 353-365 Crossref Scopus (4) Google Scholar Chronic atrial pacing was known to be associated with a lower incidence of AF in patients with sick sinus syndrome. 3 Andersen H.R. Thussen L. Bagger J.P. Vesterlund T. Thomsen P.E.B. Prospective randomised trial of atrial versus ventricular pacing in sick sinus syndrome. Lancet. 1992; 344: 1523-1528 Abstract Scopus (423) Google Scholar Recently, atrial septal pacing has been reported to be effective in preventing AF recurrence. 4 Spencer W. Zhu D.W.X. Markowitz T. Badruddin S.M. Zoghbi W.A. Atrial septal pacing A method for pacing both atria simultaneously. PACE. 1992; 20: 2739-2745 Crossref Scopus (61) Google Scholar , 5 Katsivas A. Manolis A.G. Lazaris E. Vassilopoulos C. Louvros N. Atrial septal pacing to synchonize atrial depolarization in patients with delayed interatrial conduction. PACE. 1992; 21: 2220-2225 Crossref Scopus (59) Google Scholar , 6 Bailin S.J. Johnson W.B. Hoyt R. A prospective randomized trial of Bachmann’s bundle pacing for the prevention of atrial fibrillation (abstr). J Am Coll Cardiol. 1992; 29: 74A Google Scholar , 7 Bailin S.J. Adler S.W. Giudici M.C. Hill M.R.S. Solinger B. Bachmann’s bundle pacing for the atrial fibrillation: initial trends in a multi-center randomized prospective study (abstr). PACE. 1992; 22: 727 Google Scholar , 8 Padeletti L. Porciani C. Antonio M. Colella A. Ticci P. Vena S. Costoli A. Ciapetti C. Pieragnoli P. Gensini G.F. Interatrial septum pacing A new approach to prevent recurrent atrial fibrillation. J Intervent Cardiac Electrophysiol. 1992; 3: 35-43 Crossref Scopus (113) Google Scholar However, the electrophysiologic characteristics during atrial septal pacing in patients with and without AF have not adequately been investigated. Some investigators have shown that the electrophysiologic abnormalities of the atrial muscle in patients with paroxysmal AF could be detected by P-wave signal-averaged electrocardiography (P-SAE). 9 Fukunami M. Yamada T. Ohmori M. Kumagai K. Umemoto K. Sakai A. Kondoh N. Minamino T. Hoki N. Detection of patients at risk for paroxysmal atrial fibrillation during sinus rhythm by P wave-triggered signal-averaged electrocardiogram. Circulation. 1992; 83: 162-169 Crossref Scopus (288) Google Scholar , 10 Stafford P.J. Turner I. Vincent R. Quantitative analysis of signal-averaged P waves in idiopathic paroxysmal atrial fibrillation. Am J Cardiol. 1992; 68: 751-755 Abstract Full Text PDF Scopus (111) Google Scholar , 11 Yamada T. Fukunami M. Ohmori M. Kumagai K. Sakai A. Kondoh N. Minamino T. Hoki N. Characteristics of frequency content of atrial signal-averaged electrocardiograms during sinus rhythm in patients with paroxysmal atrial fibrillation. J Am Coll Cardiol. 1992; 19: 559-563 Abstract Full Text PDF PubMed Scopus (57) Google Scholar , 12 Guidera S.A. Steinberg J.S. The signal-averaged P wave duration A rapid and noninvasive marker of risk of atrial fibrillation. J Am Coll Cardiol. 1992; 21: 1645-1651 Abstract Full Text PDF Scopus (200) Google Scholar Recently, it has also been reported that the risk of AF recurrence could be assessed by P-wave duration dispersion (P-dispersion) and atrial late potentials on the P-SAE. 13 Yamada T. Fukunami M. Shimonagata T. Kumagai K. Sanada S. Ogita H. Asano Y. Hori M. Hoki N. Dispersion of signal-averaged P wave duration on precordial body surface in patients with paroxysmal atrial fibrillation. Eur Heart J. 1992; 20: 211-220 Crossref Scopus (79) Google Scholar , 14 Abe Y. Fukunami M. Yamada T. Shimonagata T. Kumagai K. Kim J. Sanada S. Hori M. Hoki N. Prediction of transition to chronic atrial fibrillation in patients with paroxysmal atrial fibrillation by signal-averaged electrocardiography A prospective study. Circulation. 1992; 96: 2612-2616 Crossref Scopus (104) Google Scholar The aim of this study was to clarify the electrophysiologic mechanism for preventing AF recurrence by atrial septal pacing from the viewpoint of P-dispersion and atrial late potentials.