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Randomized Prospective Pilot Study of Long-Term Dual-Site Atrial Pacing for Prevention of Atrial Fibrillation

      Objective

      To determine whether dual-site atrial pacing is feasible, safe, and effective.

      Design

      We undertook a randomized prospective single-blind crossover study.

      Material and Methods

      Nine patients with at least two episodes per month of symptomatic paroxysmal atrial fibrillation participated in a randomized crossover study involving three separate 3-month blocks of single-site atrial pacing, dual-site atrial pacing, and control (supportonly) pacing.

      Results

      Dual-site atrial pacing resulted in shorter P wave duration (81 ± 14 ms) than did single-site pacing (111 ± 12 ms) or control sinus rhythm (123 ± 9 ms) (P< 0.0001) and in fewer premature atrial complexes on Holter monitoring (P = 0.06). The arrhythmia-free interval was longer with dual-site pacing (67 ± 17 days) than with single-site (62 ± 30 days) or support-only (49 ± 34 days) pacing (P = 0.10). This pilot study was not statistically powered to detect a difference between pacing modes.

      Conclusion

      (1) Dual-site atrial pacing is feasible and safe; (2) it shortens the P wave duration and tends to decrease premature atrial complexes on Holter monitoring; (3) any atrial pacing tends to prolong the arrhythmiafree interval; and (4) this pilot study enrolled too few patients to determine whether a significant difference in pacing modes exists and supports the need for a larger study.
      AV (atrioventricular), ECG (electrocardiographic), PACs (premature atrial complexes), ppm (pulses per minute)
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