Long-Term Safety and Feasibility of Right Atrial Septal Pacing with Lumenless Leads in Patients with Sick Sinus Syndrome

TL;DR

This study shows that right atrial septal pacing with lumenless leads is as safe as traditional methods and reduces the risk of atrial fibrillation in patients with sick sinus syndrome.

Contribution

Demonstrates the long-term safety and effectiveness of lumenless leads for right atrial septal pacing in reducing atrial fibrillation.

Findings

RASp with LLLs had a significantly shorter implantation time compared to RAAp with SDLs.

RASp was associated with a lower incidence of AF episodes and new-onset AF compared to RAAp.

Both methods showed similar success rates and no serious complications during long-term follow-up.

Abstract

Right atrial appendage pacing (RAAp) may increase the risk of atrial fibrillation (AF), compared to right atrial septal pacing (RASp). However, the implantation of atrial septal stylet-driven leads (SDLs) for RASp can present procedural challenges and limit its clinical application. We evaluated the long-term safety and feasibility of using lumenless leads (LLLs) with the delivery sheath for RASp and SDLs for RAAp, and compared AF events between the RASp and RAAp in patients with sick sinus syndrome.

A total of 329 patients with sick sinus syndrome who underwent pacemaker implantation were divided into 2 groups, based on the site of atrial lead placement: the RASp group (n = 162) with LLLs, and the RAAp group (n = 167) with SDLs. Implantation success rate, procedural time, P-wave characteristics, pacing parameters, complications, and AF episodes were compared between the 2 groups.

The success rates were similar for the RASp and RAAp groups (98.8% vs 97.6%, P > 0.05). The lead implantation time was significantly shorter in the RASp group (2.5 ± 1.9 minutes vs 10.3 ± 2.9 minutes, P < 0.05). During a mean follow-up of 36.4 ± 20.5 months, the pacing parameters remained stable without serious complications. Additionally, the RASp group had a significantly reduced incidence of AF episodes (6.7% vs 14.0%, P < 0.05) and new-onset AF (1.8% vs 4.6%, P < 0.05).

The long-term safety and feasibility of RASp with LLLs were comparable to those of RAAp patients with SDLs. The RASp reduced the incidence of postoperative AF episodes and new-onset AF. The RASp by delivery sheath implantation is a safe and effective method.

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