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Atriale Stimulation zur Prävention von Vorhofflimmern

Einfluss der septalen atrialen Stimulation mit atrialer Überstimulation und optimierter AV-Zeit auf die Vorhofflimmerlast

Atrial pacing for prevention of atrial fibrillation

Influence of septal atrial pacing, atrial overdrive and AV-delay-optimization on atrial fibrillation burden

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Herzschrittmachertherapie + Elektrophysiologie Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Studien haben gezeigt, dass die atriale Überstimulation bzw. Optimierung der interatrialen Leitungszeit die Vorhofflimmerlast reduzieren kann. Eine vermehrte ventrikuläre Stimulation erhöht die Inzidenz von Vorhofflimmern (AF).

Patienten und Methode

Bei 25 Patienten mit paroxysmalem AF wurde ein Zweikammerschrittmacher (Identity DR 5370, Fa. St. Jude Medical) implantiert. Nach Randomisierung wurde die atriale Elektrode entweder septal (n=12) oder lateral/Herzohr (n=13) platziert, die atriale Überstimulation (DAO) aktiviert und die AV-Zeit nach Koglek optimiert. Nach 3, 6, 9 und 12 Monaten wurde der Mode-Switch-Anteil (Vorhofflimmerlast) erfasst.

Ergebnisse

Es traten keine signifikant verlängerten Implantationszeiten der septalen Sonde auf. Die technischen Implantationsparameter lagen für beide Gruppen im Normbereich. Nach 12 Monaten zeigte sich eine geringere Vorhofflimmerlast in der septal stimulierten Gruppe (1% vs. 7%; p=0,06), wobei auch die Gesamtzahl der AF-Episoden septal geringer war.

Schlussfolgerung

Die septale Vorhofstimulation ist sicher. In Kombination mit DAO und optimierter AV-Zeit führt sie zu einer Reduktion der Vorhofflimmerlast, welche sich nach 12 Monaten abzeichnet.

Abstract

Background

Atrial overdrive and optimized interatrial conduction time can reduce atrial fibrillation (AF). Increased ventricular stimulation results in a higher incidence of atrial fibrillation.

Patients and methods

In 25 patients with paroxysmal AF, a dual-chamber pacemaker (Identity DR 5370, St. Jude Medical) was implanted. Atrial leads were placed randomly either septal (n=12) or conventional (n=13). Dynamic atrial overdrive (DAO) was activated and the AV delay was optimized according to Koglek’s method. After 3, 6, 9, and 12 months automatic mode switch (AF burden) was analysed.

Results

No difference in implantation parameters were observed between groups. Technical implantation parameters were in the normal range for both groups. After 12 months patients in the septal group had less AF burden (1% vs. 7%, p=0.06), and the total number of AF episodes was reduced.

Conclusion

Septal pacing is safe. In combination with DAO and AV delay optimization it may reduce the AF burden, which can be observed after 12 months.

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  1. Abteilung Kardiologie/Angiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland

    M. Klein, N. Klein & D. Pfeiffer

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  1. M. Klein
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  2. N. Klein
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  3. D. Pfeiffer
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Correspondence to M. Klein.

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Klein, M., Klein, N. & Pfeiffer, D. Atriale Stimulation zur Prävention von Vorhofflimmern. Herzschr. Elektrophys. 20, 148–153 (2009). https://doi.org/10.1007/s00399-009-0057-2

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