1. Efficacy of low interatrial septum and right atrial appendage pacing for prevention of permanent atrial fibrillation in patients with sinus node disease: results from the electrophysiology-guided pacing site selection (EPASS) study
- Author
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Antonello Perucca, Attilio Del Rosso, Giorgio Corbucci, P. Turrini, Maria Grazia Bongiorni, Giovanni Luca Botto, Marcello Piacenti, Maria Stella Baccillieri, Vigilio Ziacchi, Giovanni Russo, Roberto Verlato, Claudia Amellone, Riccardo Massa, and Emanuele Bertaglia
- Subjects
Male ,Time Factors ,Refractory Period, Electrophysiological ,Refractory period ,Kaplan-Meier Estimate ,law.invention ,Randomized controlled trial ,law ,Atrial Fibrillation ,80 and over ,Prospective Studies ,Prospective cohort study ,Aged, 80 and over ,Sick Sinus Syndrome ,Medicine (all) ,Cardiac Pacing, Artificial ,Atrial fibrillation ,Electrophysiological ,Sinus node disease ,medicine.anatomical_structure ,Treatment Outcome ,Italy ,Anesthesia ,Artificial ,Cardiology ,Disease Progression ,Female ,Electrophysiological study ,Electrophysiologic Techniques ,Cardiology and Cardiovascular Medicine ,Electrophysiologic Techniques, Cardiac ,Cardiac ,medicine.medical_specialty ,Atrial Appendage ,Sick sinus syndrome ,Predictive Value of Tests ,Internal medicine ,Interatrial septum pacing ,Physiology (medical) ,medicine ,Humans ,Right atrial appendage pacing ,Aged ,Atrial Septum ,Patient Selection ,Intention-to-treat analysis ,business.industry ,Refractory Period ,medicine.disease ,Cardiac Pacing ,business ,Interatrial septum - Abstract
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 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.
- Published
- 2011