The relationship of atrial electrode position and atrial fibrillation in dual chamber pacing

Introduction: This study evaluated the impact of the atrial lead implantation site on the subsequent development of atrial arrhythmias. Method: Dual chamber pacemakers were implanted in 109 consecutive patients. The indication was AV-block in 51 patients, sick sinus syndrome in 58 patients. No patient had chronic atrial fibrillation, but 12 patients(11%) had paroxysmal atrial fibrillation before implantation. Patients were classified according to the atrial lead implantation site: right atrial appendage and right atrial free wall. Results: Preimplant episodes of atrial fibrillation were similar in patients with lead implantation at the free wall and with implantation in the right atrial appendix (13% vs 7.5%, P = 0.53). During a mean follow-up of 24 +/- 13 months, new paroxysmal atrial fibrillation occurred in 5% after lead implantation in the appendix vs 28% of patients after implantation at the right atrial free wall (P = 0.004). Conclusion: The development of atrial arrhythmias in dual chamber pacing is influenced by the implantation site of the atrial lead. The frequency of atrial arrhythmias during follow-up is higher after atrial lead implantation at the right lateral wall than in the appendix.