+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Left atrial reverse remodeling and prevention of progression of atrial fibrillation with atrial resynchronization device therapy utilizing dual-site right atrial pacing in patients with atrial fibrillation refractory to antiarrhythmic drugs or catheter ablation



Left atrial reverse remodeling and prevention of progression of atrial fibrillation with atrial resynchronization device therapy utilizing dual-site right atrial pacing in patients with atrial fibrillation refractory to antiarrhythmic drugs or catheter ablation



Journal of Interventional Cardiac Electrophysiology 40(3): 245-254



Dual-site right atrial pacing (DAP) produces electrical atrial resynchronization but its long-term effect on the atrial mechanical function in patients with refractory atrial fibrillation (AF) has not been studied. Drug-refractory paroxysmal (PAF) and persistent AF (PRAF) patients previously implanted with a dual-site right atrial pacemaker (DAP) with minimal ventricular pacing modes (AAIR or DDDR mode with long AV delay) were studied. Echocardiographic structural (left atrial diameter [LAD] and left ventricular [LV] end diastolic diameter [EDD], end systolic diameter [ESD]) and functional (ejection fraction [EF]) parameters were serially assessed prior to, after medium-term (n = 39) and long-term (n = 34) exposure to DAP. During medium-term follow-up (n = 4.5 months), there was improvement in left atrial function. Mean peak A wave flow velocity increased with DAP as compared to baseline (75 ± 19 vs. 63 ± 23 cm/s, p = 0.003). The long-term impact of DAP was studied with baseline findings being compared with last follow-up data with a mean interval of 37 ± 25 (range 7-145) months. Mean LAD declined from 45 ± 5 mm at baseline to 42 ± 7 mm (p = 0.003). Mean LVEF was unchanged from 52 ± 9 % at baseline and 54 ± 6 % at last follow-up (p = 0.3). There was no significant change in LV dimensions with mean LVEDD being 51 ± 6 mm at baseline and 53 ± 5 mm at last follow-up (p = 0.3). Mean LVESD also remained unchanged from 35 ± 6 mm at baseline to 33 ± 6 mm at last follow-up (p = 0.47). During long-term follow-up, 30 patients (89 %) remained in sinus or atrial paced rhythm as assessed by device diagnostics at 3 years. DAP can achieve long-term atrial reverse remodeling and preserve LV systolic function. DAP when added to antiarrhythmic drug (AAD) and/or catheter ablation (ABL) maintains long-term rhythm control and prevents AF progression in elderly refractory AF patients. Reverse remodeling with DAP may contribute to long-term rhythm control.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 054097441

Download citation: RISBibTeXText

PMID: 25080310

DOI: 10.1007/s10840-014-9931-x


Related references

Long-term rhythm control of drug-refractory atrial fibrillation with "hybrid therapy" incorporating dual-site right atrial pacing, antiarrhythmic drugs, and right atrial ablation. American Journal of Cardiology 93(5): 569-575, 2004

Catheter ablation of inducible atrial flutter, in combination with atrial pacing and antiarrhythmic drugs ("hybrid therapy") improves rhythm control in patients with refractory atrial fibrillation. Journal of Interventional Cardiac Electrophysiology 6(2): 165-172, 2002

Dual site right atrial pacing can improve the impact of standard dual chamber pacing on atrial and ventricular mechanical function in patients with symptomatic atrial fibrillation: further observations from the dual site atrial pacing for prevention of atrial fibrillation trial. Journal of Interventional Cardiac Electrophysiology 12(3): 177-187, 2005

Relevance of electrical remodeling in human atrial fibrillation: results of the Asymptomatic Atrial Fibrillation and Stroke Evaluation in Pacemaker Patients and the Atrial Fibrillation Reduction Atrial Pacing Trial mechanisms of atrial fibrillation study. Circulation. Arrhythmia and Electrophysiology 5(4): 626-631, 2012

Pre-Procedural Serum Atrial Natriuretic Peptide Levels Predict Left Atrial Reverse Remodeling After Catheter Ablation in Patients With Atrial Fibrillation. Jacc. Clinical Electrophysiology 2(2): 151-158, 2016

Effectiveness of rhythm control in persistent or permanent atrial fibrillation with overdrive atrial pacing and antiarrhythmic drugs after linear right atrial catheter ablation. American Journal of Cardiology 92(9): 1037-1044, 2003

Is there a role for bi-atrial pacing resynchronisation therapy in the management of drug-refractory atrial fibrillation in patients unsuitable for left atrial ablation?. Circulation Journal 75(1): 67-72, 2011

Association between left and right atrial remodeling with atrial fibrillation recurrence after pulmonary vein catheter ablation in patients with paroxysmal atrial fibrillation: a pilot study. Circulation. Cardiovascular Imaging 4(5): 524-531, 2011

Effect of dual site right atrial pacing on burden of atrial fibrillation in patients with drug-refractory atrial fibrillation. Journal of the American College of Cardiology 35(2 Suppl A): 109A, 2000

Multisite atrial pacing: An option for atrial fibrillation prevention? Preliminary results of the Dutch dual-site right atrial pacing for prevention of atrial fibrillation study. American Journal of Cardiology 86(Suppl 9A): 20K-24K, 2000

Catheter ablation of atrial fibrillation versus atrioventricular junction ablation plus pacing therapy for elderly patients with medically refractory paroxysmal atrial fibrillation. Journal of Cardiovascular Electrophysiology 16(5): 457-461, 2005

Neutral effects of statins to prevent atrial fibrillation recurrences after catheter ablation of atrial fibrillation: should we bury upstream therapy for secondary prevention of atrial fibrillation?. Heart Rhythm 9(2): 179-180, 2012

Relationship between complex fractionated atrial electrograms during atrial fibrillation and the critical site of atrial tachycardia that develops after catheter ablation for atrial fibrillation. Journal of Cardiovascular Electrophysiology 25(2): 146-153, 2014

Regional right and left atrial activation patterns during single- and dual-site atrial pacing in patients with atrial fibrillation. American Journal of Cardiology 82(10): 1197-1204, 1998

Dual site atrial pacing is effective for atrial fibrillation prevention in patients with and without atrial conduction delay. Journal of the American College of Cardiology 37(2 Suppl. A): 95A, 2001