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Can Bi-Atrial Pacing Slow the Progression of Paroxysmal Atrial Fibrillation to Permanent Atrial Fibrillation?

INTRODUCTION: Bi-atrial lead placement combined with atrial overdrive pacing has demonstrated a reduction in percent time mode switched and mode switches per day. This retrospective analysis compared long term outcomes of patients with right atrial overdrive pacing alone (DAO) to patients having atrial overdrive with bi-atrial leads (BIA) in slowing the progression of paroxysmal atrial fibrillation (PAF) to permanent continuous atrial fibrillation (CAF).

METHODS: Thirty-three patients age 76.6 (+/-1.96) from our prior investigation were selected. The DAO control group (N=16) and had received a standard right atrial pacing lead. The BIA group (N=17) had pacing leads placed in the right atrium and coronary sinus. Patients were followed for a mean 1217 days (+/-838). Days of CAF was classified as the date of final mode switch until analysis.

RESULTS: A total of 40,171 follow-up days were evaluated. The mean follow-up for both cohorts was 1217 days (+/-838). The DAO group consisted of 15,318 days (mean 957 +/-761) and the BIA group 24,853 days (mean 1461 +/-854).  A lower total number of days were spent in CAF in the BIA group versus the DAO group, 1380 vs 2197 respectively.  Corrected for follow-up duration, 5.55% days in CAF was seen in the BIA group vs. 14.34% in the DAO group which did not reach statistical significance. 

CONCLUSIONS: Although BIA overdrive pacing initially demonstrated reduced time in mode switch compared to DAO alone, this analysis did not detect a reduction in progression to CAF. More subjects or a longer follow up would be needed.

Credits: Raffaele Corbisiero; Kathleen Zazzali DO; David Muller

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