Right atrial appendage pacing

Padeletti L, Pieragnoli P, Ciapetti C, et al. Randomized crossover comparison of right atrial appendage pacing versus interatrial septum pacing for prevention of paroxysmal atrial fibrillation in patients with sinus bradycardia. Am Heart J 2001 142 1045-55. 

Grilfin JC Sensing characteristics of the right atrial appendage electrode. PACE 1983 6 22-25. 

Fig. 4.69 Atrial lead placement. Insert in the upper right shows atrial endocardial lead being placed through the wall of the right atrial appendage with the tip of the pacemaker lead abutting the endocardial surface. A pursestring suture is placed around the lead at the point of entry. The relationship of the atrial lead is also shown. (Hayes DL, Vhetstra RE, Puga FJ, et al. A novel approach to atrial endocardial pacing. Pacing Clin Electrophysiol 1989 12(1 Pt 1) 125-130, with permission.)...

Fig. 4. 96 Right anterior oblique (RAO) (panel A) and left anterior oblique (LAO) (panel B) sections of the male heart obtained from the EPFL s visible human surface server, EPFL 1998. Panel A shows the inferior caval vein (ICV), the inferior isthmus (CTI), the supraventricular crest (SVC), the aorta (Ao), and right ventricular outflow tract (RVOT). The white dot signals the site corresponding to the membranous septum or the maximal His-Bundle potential is usually recorded. In the LAO projection, the right atrial appendage (RAA) and the right and left atria at the level of the atrial ventricular junction s are depicted. The white dot also signals the area were the his bundle is recorded. The left atrial appendage (LAA) is superior, (from Farre J, Anderson RH, Cabrera JA, et al Fluorscopic cardiac anatomy for catheter ablation of tachycardia. PACE 25 88, 2002)...

With the above considerations, there is need for long-term, randomized studies that include a well-defined patient population and multiple weU-defined pacing sites that evaluate functional hemodynamics, lead stability, extractability, and complication data. Until such time, the right atrial appendage and right ventricular apex, with proven reliability, stability, and simplicity, should not be abandoned. 

Bennett DH. Comparison of the acute effects of pacing the atrial septum, right atrial appendage, coronary sinus os, and the latter two sites simultaneously on the duration of atrial activation. Heart 2000 84 193—6. 

Figure 18.20 depicts dual-site atrial pacing used to decrease paroxysmal atrial fibrillation. In this example, one lead is positioned in the right ventricular apex, another in the right atrial appendage, and a third in the posterior portion of the right atrium near the coronary sinus ostium. 

Fig. 4.97 Axial section of the heart obtained from the visible human surface server. Right superior pulmonary vein (RSPV), left superior pulmonary vein (LSPV) and left atrial appendage (LAA). PACE 25 88, 2002. (from Farre J, Anderson RH, Cabrera JA, et al Fluorscopic cardiac anatomy for catheter ablation of tachycardia. PACE 25 88, 2002)...

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