Role of Atrial Pacing Sites For Prevention of Atrial Fibrillation

摘要

The right atrial appendage is not an ideal pacing site for the prevention of atrial fibrillation (af). The P wave duration during right atrial appendage or high right atrial pacing is much longer than that during sinus rhythm. Atrial refractory period dispersion is enlarged by conventional atrial pacing. In patients with a prolonged P wave duration due to inter- or intra-atrial conduction delay, single-site right atrial pacing can not simultaneously optimize both right and left side atrioventricular timing, and left side atrioventricular timing is very short and completion of the left atrial kick is so delayed that the atrial contribution may be interrupted by the ventricular contraction. To solve the problems, multisite atrial pacing and alternative single right atrial pacing have been tried. The duration of the P wave is shortened by multisite atrial pacing or Bachmann's bundle pacing. However, there is no sufficient single technique to suppress af. Prevention of af can be achieved by combination therapy of atrial pacing at optimal sites and antiarrythmic drugs, and sometimes catheter ablation.