Sumiyoshi Hironobu, Tasaka Hiroshi, Yoshida Kenta, Yoshino Mitsuru, Kadota Kazushige
Department of Cardiovascular Medicine Kurashiki Central Hospital Kurashiki Japan.
J Arrhythm. 2023 Jun 26;39(4):566-573. doi: 10.1002/joa3.12888. eCollection 2023 Aug.
It is unknown whether atrial fibrillation (AF) burden varies by pacing site in patients with reactive atrial antitachycardia pacing (rATP). We aimed to compare AF burden in patients with high atrial septal pacing (HASp) via delivery catheter and right atrial appendage pacing (RAAp) in patients with sick sinus syndrome (SSS).
We retrospectively identified 109 patients with a history of paroxysmal AF and SSS who had received dual-chamber pacemaker implantation between January 2017 and December 2019, of whom 39 and 70 patients had HASp and RAAp, respectively. rATP was initiated after a 1-month post-implantation run-in period.
Patients with HASp had a significantly shorter P-wave duration during atrial pacing than those with RAAp (99.3 ± 10.4 vs. 116.0 ± 14.3 ms, < .001). During the 3-year follow-up period, the incidence of an AF lasting longer than 1 or 7 days was significantly lower (hazard ratio [HR], 0.45; = .016; HR, 0.24; = .004) than in those with RAAp. The median time of AF/AT per day in the follow-up periods was significantly shorter in the HASp group than in the RAAp group (10 vs. 18 min/day, = .018). Atrial lead division did not occur in the HASp group during the follow-up period.
HASp via delivery catheter is as safe as RAAp, and HASp combined with rATP is effective for reducing AF burden in patients with SSS and paroxysmal AF.
在反应性心房抗心动过速起搏（rATP）患者中，房颤（AF）负荷是否因起搏部位而异尚不清楚。我们旨在比较病态窦房结综合征（SSS）患者中经输送导管进行高位房间隔起搏（HASp）与右心耳起搏（RAAp）时的房颤负荷。
我们回顾性纳入了2017年1月至2019年12月期间接受双腔起搏器植入的109例阵发性房颤和SSS病史患者，其中分别有39例和70例患者接受了HASp和RAAp。在植入后1个月的磨合期后启动rATP。
HASp患者在心房起搏期间的P波时限明显短于RAAp患者（99.3±10.4 vs. 116.0±14.3 ms，P<0.001）。在3年随访期间，持续时间超过1天或7天的房颤发生率显著低于RAAp患者（风险比[HR]，0.45；P=0.016；HR，0.24；P=0.004）。随访期间HASp组每天房颤/房性心动过速的中位时间明显短于RAAp组（10 vs. 18分钟/天，P=0.018）。随访期间HASp组未发生心房导线断裂。
经输送导管进行HASp与RAAp一样安全，HASp联合rATP可有效降低SSS和阵发性房颤患者的房颤负荷。
