Atrial septal pacing

Padeletti L, Michelucci A, Pieragnoli P, et al. Atrial septal pacing a new approach to prevent atrial fibrillation. J Intervent Cardiac Electrophysiol 1999 3 35. 

Hermida JS, Kulbala M, Lescure EX, et al. Atrial septal pacing to prevent atrial fibrillation in patients with sinus node dysfunction results of a randomized controlled study. Am Heart J 2004 148 312-7. 

To do a tnalpositioned atrial septal lead can be deleterious, possibly causing pacemaker syndrome or, if high-rate atrial tachyarrhythmia therapy pacing is used, may result in inappropriate, dangerously high ventricular rates. 

Padeletti L, Purerfellner H, Adler SW, Waller TJ, Harvey M, Horvitz L, Holbrook R, Kempen K, Mugglin A, Hettrick DA. Combined efficacy of atrial septal lead placement and atrial pacing algorithms for prevention of paroxysmal atrial tachyarrhythmia. J Cardiovasc Electrophysiol. 2003 14 1189-1195. 

Bennett et al. reported that atrial activation times were similar when pacing from the CS os, Bachmann s Bnndle or the interatrial septum (30). Of these three options, septal lead placement may be preferable given its relative lack of technical complexity. Indeed, Hermida et al. showed no difference in feasibility and reliability comparing septal and RAA pacing sites, whereas septal pacing was associated with shorter interatrial activation times and reduced left atrial electromechanical delay (36). 

Hermida J, Carpentier C, Kubala M, et al. Atrial septal versus atrial appendage pacing feasibility and effects on atrial conduction, interatrial synchronization and atrioventricular sequence. Pacing Cfin Electrophysiol 2003 26 [Pt. l] 26-35. 

Duytschaever M, Eirsovaite V, Colpaert R, et al. Limited benefit of septal pre-excitation in pace prevention of atrial fibrillation. J Cardiovasc Electrophysiol 2005 16 269-77. 

Fig. 18.15 Posteroanteiior (i4) and lateral (B) chest radiographs of a dual-chamber pacing system. The atrial lead is positioned in a septal position (arrow). This patient had extremely long intra-atrial conduction times, and septal placement was the only way to maintain effective atrioventricular synchrony.

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