PREVENTION OF ATRIAL FIBRILLATION BY BIATRIALPACING: THE OUTCOME AND THE ELECTROPHYSIOLOGICAL MECHANISM OF PREVENTION

摘要

We previously reported the superiority in AF prevention by biatrial pacemaker (BAP) for a short term period. The purpose of this study is comparing the preventive effect of AF for a long time period and assessing the mechanism of prevention by BAP. Twelve patients with paroxysmal AF received BAP with 2 leads in the right atrium and coronary sinus. A crossover trial between BAP and right atrial pacing (RAP) was performed every 3 month. Non-invasive EP study for measuring the effective refractory period (ERP) of both atria and inducing AF was done after every 3 month of pacing. Results: The mean follow-up period was 33+-7 months. Although AF episodes tended to decrease even by the RAP, they were more prominent by BAP (p<0.01). P wave width was shortest during BAP (p<0.01). The difference of ERP (delta ERP) between both atria was shorter after 3 months of BAP than RAP (P<0.05). There was a positive relationship between delta ERP and AF(r=0.508, p<0.01). AF induction by EP study was higher by RAP than BAP (p<0.01). Conclusion: BAP is superior in AF prevention for a long time period. The correction of conduction disturbances and dispersion of refractoriness are the main cause of AF prevention.