Cardiology Service, University Hospital, 4, Rue Gabrielle-Gentil, Geneva 1211, Switzerland.
Europace. 2011 Sep;13(9):1262-7. doi: 10.1093/europace/eur099. Epub 2011 Apr 6.
Patients with interatrial conduction delay may have suboptimal left atrioventricular (AV) timing due to delayed contraction of the left atrium with foreshortening of ventricular filling. This may be an issue in pacemaker patients, especially those requiring resychronization therapy. Pacing from the high interatrial septum (IAS) or the distal or proximal coronary sinus (CSD and CSP) may improve left AV synchrony compared with pacing from the right atrial appendage (RAA). Our aim was to compare haemodynamics of these pacing sites.
A total of 24 patients undergoing radiofrequency ablation for paroxysmal atrial fibrillation were studied. Left atrial pressures were recorded in sinus rhythm, and during pacing from the RAA, IAS, CSD, CSP, and with biatrial (BiA) pacing from the IAS + CSD. Amplitudes, +dP/dT(max), and timing of the a-wave were compared between recordings. Left atrial contractility, measured by +dP/dT(max), was greatest during BiA pacing (P ≤ 0.03 for all comparisons). There was a marked reduction in delay to peak a-wave when pacing from all sites compared with the RAA, with BiA pacing yielding the shortest delay (P ≤ 0.001). However, AV conduction was shortened by all alternative pacing sites, which mitigated the anticipation of left atrial contraction with respect to ventricular activation, except for BiA pacing (P < 0.001). Pacing of the IAS did not result in any improvement in haemodynamics or AV synchrony.
Multisite atrial pacing results in favourable acute atrial haemodynamics and left AV synchrony. This may be a solution in pacemaker patients with interatrial conduction delay.
由于左心房收缩延迟导致左心房缩短，心室充盈缩短，房间隔传导延迟的患者可能会出现左房室（AV）时间不理想。这在起搏器患者中可能是一个问题，尤其是那些需要再同步治疗的患者。与从右心耳（RAA）起搏相比，从高房间隔（IAS）或远端或近端冠状窦（CSD 和 CSP）起搏可能会改善左 AV 同步性。我们的目的是比较这些起搏部位的血液动力学。
共对 24 例因阵发性心房颤动而行射频消融的患者进行了研究。窦性心律时记录左心房压力，并在 RAA、IAS、CSD、CSP 起搏时以及在 IAS + CSD 进行双房（BiA）起搏时记录左心房压力。比较记录之间的 a 波幅度、+dP/dT(max) 和 a 波时间。用+dP/dT(max) 测量左心房收缩力，BiA 起搏时最大（所有比较 P ≤ 0.03）。与 RAA 起搏相比，所有起搏部位的 a 波峰值延迟明显缩短，BiA 起搏时延迟最短（P ≤ 0.001）。然而，除 BiA 起搏外（P < 0.001），所有替代起搏部位的 AV 传导均缩短，这减轻了左心房收缩相对于心室激活的提前。IAS 起搏并不能改善血液动力学或 AV 同步性。
多部位心房起搏可改善急性心房血液动力学和左 AV 同步性。对于存在房间隔传导延迟的起搏器患者，这可能是一种解决方案。
