Key result
Alternative RA septum or continuous atrial overdrive pacing fails to prevent persistent AF vs conventional pacing.
Why the study?
Does alternative site pacing at the RA septum or continuous atrial overdrive pacing prevent the development of persistent AF in patients with paroxysmal AF and sick sinus syndrome?
Population
385 patients with paroxysmal atrial fibrillation and sick sinus syndrome in whom a pacemaker was indicated
Comparison
Alternative site pacing at the low right atrial… vs Conventional pacing at the right atrial…
Design
RCT, Randomized to 4 groups: RA appendage ON, RA appendage OFF, RA septum ON…
Follow-up
mean 3.1 years
Authors
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Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“A significant proportion of patients with SSS developed persistent AF, despite the use of modern pacemaker technologies. Other treatment strategies should, therefore, be further investigated for the secondary prevention of AF in patients with SSS.”
“Continuous conventional site atrial pacing in the ASSERT study and, at an alternative site, in the Septal Pacing for Atrial Fibrillation Suppression Evaluation (SAFE) study did not show benefits. On the contrary, continuous pacing was not tolerated by the patients, and it accelerated battery depletion.”
Site-specific atrial pacing may influence persistent AF risk in sinus node disease; leaves open optimal strategies for randomized confirmation.
RCT (n=385)
Does alternative site pacing at the RA septum or continuous atrial overdrive pacing prevent the development of persistent AF in patients with paroxysmal AF and sick sinus syndrome?
Hazard Ratio: 1.18 (95% CI 0.79–1.75)
p-value: p=0.65
In patients with sick sinus syndrome and paroxysmal AF, neither alternative pacing at the RA septum nor continuous atrial overdrive pacing prevented the progression to persistent AF compared to conventional RA appendage pacing.
Lau et al. (2013) conducted an RCT in paroxysmal atrial fibrillation and sick sinus syndrome (n=385). Right atrial septum pacing and/or continuous atrial overdrive pacing vs. Right atrial appendage pacing and/or no continuous atrial overdrive pacing was evaluated on occurrence of persistent AF (AF documented at least 7 days apart or need for cardioversion) (HR 1.18, 95% CI 0.79-1.75, p=0.65). Alternative site pacing at the RA septum (HR 1.18; 95% CI 0.79-1.75) or continuous atrial overdrive pacing (HR 1.17; 95% CI 0.79-1.74) did not prevent persistent AF compared to conventional pacing.