Abstract
Pace prevention of atrial tachyarrhythmias is based in part on the reduction of intra-atrial (IAA) and/or inter-atrial (IEA) conduction. We previously introduced a novel pacing mode using floating atrial ring electrodes on a VDD-lead (BIdirectional MO nophasic impulSe: BIMOS). The effects of BIMOS pacing on IAA and IEA conduction times has not been studied. In nine Merino sheep electrode catheters were placed at the His-Bundle (HBE), high right atrium (HRA), coronary sinus ostium (Cs-Os), and left lateral atrium (LLA). A VDD-lead was introduced with floating electrodes in the high and mid right atrium (Floating). IAA (S/P-HRA, S/P-Cs-Os, S/P-HBE, S/P-Floating), IEA conduction times (S/P-LLA), and P-wave duration (PD) were measured during sinus rhythm (S), during bipolar cathodal pacing (P) in the HRA, in the Cs-Os position, as well as during BIMOS floating pacing. The mean PD during S was significantly shorter than during HRA- (66.6±12.8ms; vs. 116.2±11.1ms; p<0.05) and Cs-Os-P (66.6±12.8ms vs. 94.4±9.0ms; p<0.05). In comparison to HRA-P, BIMOS configuration lead to a significant reduction of the P-wave duration (116.2±11.1ms vs. 85.4±8.8ms; p<0.05). During BIMOS pacing, the global atrial conduction time was significantly shorter than during pacing in the HRA and Cs-Os position. The results of this study demonstrate a clear reduction of IAA and IEA conduction times using BIMOS configurations compared to conventional HRA-P. Furthermore, BIMOS pacing produced a more homogeneous atrial activation when compared with conventional HRA- and Cs-Os-P.
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References
Moe GK. On the multiple wavelet hypothesis of atrial fibrillation. Arch Int Pharmacodyn Ther 1962;140: 183-188.
Allessie M, Konings K, Wijffels M. Electrophysiological mechanism of atrial fibrillation. In: DiMarco JP, Prystowsky EN, ed. Atrial Arrhythmias: State of the Art, Amonk, NY: Futura Publishing Co, 1995;155-161.
Cosio FG, Palacios J, Vidal JM, Cocina EG, Gomez-Sanchez MA, Tamargo L. Electrophysiologic studies in atrial fibrillation. Slow conduction of premature impulses: A possible manifestation of the background for reentry. Am J Cardiol 1983;51:122-130.
Buxton AE, Waxman HL, Marchlinski FE, Josephson ME. Atrial conduction: Effects of extrastimuli with and without atrial dysrhythmias. Am J Cardiol 1984;54: 755-761.
Daubert C, Gras D, Berder V, Leclercq C, Mabo P. Permanent atrial resynchronization by synchronous bi-atrial pacing in the preventive treatment of atrial flutter associated with high degree interatrial block. Arch Mal Coeur Vaiss 1994;87(11 Suppl):1535-1546.
Papageorgiou P, Monahan K, Boyle NG, Seifert MJ, Beswick P, Zebede J, Epstein LM, Josephson ME. Site-dependent intra-atrial conduction delay; relationship to initiation of atrial fibrillation. Circulation 1996;94: 384-388.
Daubert JC, Leclercq C, Pavin D, Mabo P. Biatrial synchronous pacing: A new approach to prevent arrhythmias in patients with atrial conduction block. In: Daubert CJ, Prystowsky EN, Ripart A, eds. Prevention of tachyarrhythmias with cardiac pacing. Armok, Futura Publishing Company, 1997;99-119.
Papageorgiou P, Anselme F, Kirchhof CJHJ, Monahan K, Rasmussen CAF, Epstein LM, Josephson ME. Coronary sinus pacing prevents induction of atrial fibrillation. Circulation 1997;96:1893-1898.
Prakash A, Saksena S, Hill M, Krol RB, Munsif AN, Giorgberidze I, Mathew P, Mehra R. Acute effects of dual-site right atrial pacing in patients with spontaneous and inducible atrial flutter and fibrillation. Am Coll Cardiol 1997;29 (5):1007-1014.
Prakash A, Delfaut P, Krol RB, Saksena S. Regional right and left atrial activation patterns during single-and dual-site atrial pacing in patients with atrial fibrillation. Am J Cardiol 1998;82 (10):1197-1204.
Saksena S, Prakash A, Hill M, Krol RB, Munsif AN, Mathew PP, Mehra R. Prevention of recurrent atrial fibrillation with chronic dual-site right atrial pacing. J Am Coll Cardiol 1996;28 (3):687-694.
Padeletti L, Porciani MC, Michelucci A, Colella A, Vena S, Ticci P, Gensini GF. Interatrial septum pacing: A new approach to prevent paroxysmal atrial fibrillation. G Ital Cardio 1998;28 Suppl 1:4-6.
Bailin, SJ, Johnson, WB, Solinger, B. Permanent Atrial Septal Pacing; Sensing, Pacing, and Stability-Long-Term Results (abstract). PACE 1997;20, Part II, 1053.
Hartung WM, Hartung D, Auricchio A, Geller JC, Goette A, Esperer HD, Klein HU. Atrial floating pacing with a novel pacing configuration using a conventional monophasic impulse-first acute results (abstract). J Am Coll Cardiol 1998;31 (Suppl A):161A.
Hartung WM, Hidden-Lucet F, McTeague K, Honeycutt C, Langberg JJ. Overlapping biphasic stimulation: A novel pacing mode with low capture thresholds (abstract). Circulation 1994;90:1-69.
Hartung WM, Hartung D, Goette A, Auricchio A, Geller JC, Klein H, Langberg JJ. Vorhofstimulation über flottierende Elektroden. Herzschr. Elektrophys 1996;7:17-25.
Rey JL, Ghelbazouri F, Tribouilloy C. Dual chamber pacing with a single lead system: initial clinical results. PACE 1996;19 (11 Pt 2):1777-1779.
Tse HF, Lau CP, Leung SK, Leung Z, Mehta N. Single lead DDD system: A comparative evaluation of unipolar, bipolar, and overlapping biphasic stimulation and the effects of right atrial floating electrode location on atrial pacing and sensing thresholds. PACE 1996;19 (11 Pt 2):1758-1763.
Frabetti L, Sassara M, Melissano A, Del Giudice G, Mangiameli S, Audoglio R. OLBI pacing. The Italian experience. In: Vardas PE, ed. Europace 97, Monduzzi Editore, Bologna Italy, 1997; 151-157.
Hartung WM, Hartung D, Auricchio A, Geller JC, Goette A, Esperere HD, Hobrack S, Klein H. Significant reduction of atrial floating pacing capture thresholds using a conventional monophasic impulse and a novel pacing electrode configuration. First results. G Ital Cardio 1998;28 Suppl 1:36-38.
Hartung, WM, Hartung D, Auricchio A, Geller JC, Goette A, Esperer HD, Klein HU. The importance of the location of the third electrode during atrial floating pacing with a novel pacing configuration (abstract). J Am Coll Cardiol 1998;31 (Suppl C):299 C.
Gepstein L, Hayam G, Ben-Haim SA. A novel method for nonfluoroscopic catheter-based electroanatomical mapping of the heart. In vitro and in vivo accuracy results. Circulation 1997;18, 95(6):1611-1622.
Bayes de Luna A, Cladellas M, Oter R, Torner P, Guindo J, Marti V, Rivera I, Iturralde P. Interatrial conduction block and retrograde activation of the left atrium and paroxysmal supraventricular tachyarrhythmia. Eur Heart J 1988;9(10):1112-1118.
Daubert C, Mabo P, Berder V. Arrhythmia prevention by permanent atrial resynchronization in advanced interatrial block (abstr.). Eur. Heart J 1990;11:237.
Capurso S, Grotti PD, Sessa S, Perotti M, Ferri F. The PHYMOS system. Long term follow up. In: Antonioli GE, Aubert AE, Ector H, ed. Pacemaker Leads 1991, Amsterdam, New York; Elsevier Science Publishers B.V, 1991; 223-227.
Bongiomi MG, Bedendi N, Atrial Stimulation by Means of Floating Electrodes: A multicenter Experience. PACE 1992;15:1977-1981.
Di Gregorio F, Bongiorni MG, Moracchini PV, Nava A, Caprioli E, Gascon D. Single-pass lead DDD pacing: A Multicenter experience (abstract). PACE 1997;20 (Prt II):1517.
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Hartung, W.M., Hartung, D., Saad, H. et al. The Importance of Right Atrial Pacing Electrode Position and Pacing Configuration for Intra-atrial and Inter-atrial Conduction Times. J Interv Card Electrophysiol 4, 405–413 (2000). https://doi.org/10.1023/A:1009858601764
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DOI: https://doi.org/10.1023/A:1009858601764