| Objective: Atrial Fibrillation (Af) , the most common sustained cardiac arrhythmia in clinical, is often associated with underling heart disease. Af can cause the structural and functional changes of the heart and deteriorate the hemodynamic effects. Especially, when companied with congestive heart failure (CHF), it can worsen these effects and threaten the patients' life. It had been reported that Biatrial Pacing (BAP) might prevent the recurrence of Af, but in patients with paroxysmal Af (PAf) companied with CHF, how to prevent Af and to improve cardiac function are still stubborn problems. We desiged a randomized study to estimate the long-term effects of Biatrial-Right Ventricular upper Septal Pacing (BiA-RVUSP) compared with Right Atria-Right Ventricular upper Septal Pacing (RA-RVUSP) in patients with drug-refractiory PAf companied with CHF.Methods: 26 patients with drug-refractory PAf companied with CHF (NYHA II-III grade , 9 femals, average age 64.1+7.13 years) had at least 3 episodes of symptomatic PAf (S-PAf) and had failed to control theirsymptoms after taking 3 months amiodarone before they were hospitalized. After 3 months observation, they were randomized into BiA-RVUSP group (n=l 1) and RA-RVUSP group (n=15) .Antiarrhythmic medicines were unchanged during the study and all patients had regular anti-heart failure medicine therapy. The following techniques had been used to locate the pacemaker electrodes. The right-ventricular upper septal lead (1388-T active screw-in electrode) were fixed by special controller (Locator 4036) through left or right subclavian vein entry; The right atrial lead were positioned at the right appendage using common "J" electrode; The 2188 coronary sinus lead were located at coronary sinus to pace left atrium. The two atrial lead tip electrodes were cross connected to form a bipole using a Medtronic model 5866-3 8M Y connector with the right appendage lead as the cathodal electrode and the coronary sinus lead as the anodal electrode. Both BA-RVUSP group and RA-RVUSP group adopted ODD pacing mode and used dual-chamber pacemakes (Medtronic Thera 7964i; Medtronic Sigma D; Pacesetter AFFINITY DC 5230 L/R) , biatrial pacing demaned bipole pacing mode and AV duration was 150ms0 During 1 -year follow-up, we recorded the symptomatic events of PAf and the parameter changes of the two groups, including the LAd and LVEDV changes in UCG, the left ventricular systolic and diastolic function in ERNA, the patients' life-quality (Wakefield score and 6-Minute Walking Test) andthe cost of medical treatment.Results: All the patients (n=11) in BiA-RVUSP group had the completed data.Two patients were died of AMI and lung cancer in RA-RVUSP group and withdrew from the study.In BiA-RVUSP group: comparing after pacing with before pacing, LAd was decreased by 12.9% (p<0.05) , LVEDV was decreased ( 162.17 + 37.2ml vs 147.5 + 25.39ml, p>0.05) , both the amplitude of peak A and peak E had significantly increased (63.33+10.72 vs 72.17+12.08 and 59.67 + 6.85 vs 66 + 5.69, respectively, p<0.05) .LVEF in ERNA was increased by 19.7% (p<0.05 ) , TPER was shortened ( 40.17 + 19.18ms vs 131.5 ?16.65ms, p>0.05) and PFR was increased (2.45 + 0.32EDV/S vs 2.62+0.37EDV/s, p>0.05) , P wave duration was shortened (140+38ms vs 111+26ms, p<0.05) , and the distance of 6-MWT was prolonged (293.83 + 58.88m vs 359 + 61.2m, p<0.05) . The episode frequency of S-PAf was significantly decreased (14 + 3 espisodes/year vs 5 + 2 espisodes/year, p<0.02) .In RA-RVUSP group : comparing after pacing with before pacing, LVEDV was decreased (178.38+ 39.79ml vs 157.88 +28.53ml, p>0.05) while LAd was increased (39 + 6.93mm vs 43.08 + 5.65mm, p>0.05) . The amplitude of peak A was significantly decreased (69.75 + 8.44 vs 60.88 + 12.15, p<0.05) and peak E significantly increased (60.38 + 12.03 vs 69.75 + 10.21, p<0.05) .LVEF in ERNA wasincreased by 14.5% (p<0.05) , TPER was shortened (144.63 + 20.2ms vs 126.25+24.31ms, p<0.05 ) and PFR was increased (2.11 + 0.3EDV/S vs2.38 + 0.36EDV/S, p<0.05) . ECG showed P wa... |
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