Das Asit
Department of Cardiology, IPGME&R and SSKM Hospital, Kolkata, India.
Indian Heart J. 2017 Sep-Oct;69(5):675-680. doi: 10.1016/j.ihj.2017.08.030. Epub 2017 Sep 1.
Atrial pacing is done for either symptomatic sinus node dysfunction (SND) or for maintenance of atrio-ventricular synchrony in a dual chamber pacemaker. Conventionally, atrial lead is placed in the right atrial appendage. Atrial conduction disorder in patients with permanent pacing results in higher incidence of atrial fibrillation. Atrial septal pacing has emerged as a solution to this problem. So, it is extremely important to understand the different features of paced P wave from various atrial pacing sites. Conventional right atrial appendage pacing in presence of atrial conduction disorder results in marked latency with prolonged P wave duration with reduced amplitude. The morphology is similar to sinus rhythm. Atrial septal pacing causes short and sharp P wave with negative polarity in inferior leads and positive polarity in lead V1 in lower septal pacing, whereas positive polarity in inferior leads and negative polarity in lead V1 during pacing from upper septum.
心房起搏用于有症状的窦房结功能障碍（SND）或用于双腔起搏器中维持房室同步。传统上，心房导线置于右心耳。永久性起搏患者的心房传导障碍会导致房颤发生率更高。房间隔起搏已成为解决这一问题的方法。因此，了解来自不同心房起搏部位的起搏P波的不同特征极为重要。在存在心房传导障碍时，传统的右心耳起搏会导致明显延迟，P波持续时间延长且振幅降低。其形态与窦性心律相似。房间隔起搏会导致P波短而尖锐，在下壁导联呈负极性，在下间隔起搏时V1导联呈正极性，而在上间隔起搏时，下壁导联呈正极性，V1导联呈负极性。
