Atrial standstill in sinus node disease due to extensive atrial fibrosis: impact on dual chamber pacemaker implantation
Atrial standstill in sinus node disease due to extensive atrial fibrosis: impact on dual chamber pacemaker implantation
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DOI：
10.1093/europace/euv098
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发表时间：
2016-02-01
期刊：
影响因子：
6.1
通讯作者：
Schauerte, Patrick
中科院分区：
文献类型：
--
作者：
Bellmann, Barbara;Roser, Mattias;Schauerte, Patrick
目的 心房停搏的特点是心房活动缺失。我们报道了一系列病例，在有症状的窦房结疾病患者中，由于缺乏可兴奋的右心房组织，传统的心房起搏器导线植入失败，从而提示心房停搏的诊断。我们假设对心房进行标测并随后识别仍适合心房起搏的心肌将允许双腔起搏器植入。方法和结果在四名患者中，心房导线植入失败。在这些患者中，不存在自发性或纤维性颤动电活动，但尽管传统心房部位存在高刺激电压，但仍无法捕获心房。我们怀疑部分或完全心房停搏，随后通过常规（n = 1）或电解剖标测（n = 3）证实了这一假设。所有患者都存在纤维化组织区域，通过缺乏自发电活动和无法通过标测导管捕获局部电来确定。三名患者中存在幸存的心房组织，可以通过随后将活动传导至房室（AV）结来进行电捕获。所有这些患者均在这些部位成功实现了定向心房导线植入。一名患者发现孤立的窦房结活动，但未传导至心房。结论 窦房结疾病患者可能存在部分心房停顿，并妨碍心房导线植入。在这些患者中，通过映射研究识别部分心房停搏并识别与 AV 结连接的存活肌岛仍可能允许同步 AV 顺序起搏。
Aims Atrial standstill is characterized by the absence of atrial activity. We report about a series of cases, in which conventional atrial pacemaker lead implantation in patients with symptomatic sinus node disease failed due to lack of excitable right atrial tissue, thus, prompting the diagnosis of atrial standstill. We hypothesized that mapping of the atria with subsequent identification of myocardium still amenable to atrial pacing would allow dual chamber pacemaker implantation.Methods and results In four patients, atrial lead implantation failed. In these patients, spontaneous or fibrillatory electrical activity was absent but the atria could not be captured despite high stimulation voltages at conventional atrial sites. We suspected partial or complete atrial standstill and subsequently confirmed this hypothesis by conventional (n = 1) or electroanatomical mapping (n = 3). Areas of fibrotic tissue were present in all patients as identified by lack of spontaneous electrical activity and inability of local electrical capture via the mapping catheter. Surviving atrial tissue, which could be electrically captured with subsequent conduction of activity to the atrioventricular (AV) node, was present in three patients. Successful targeted atrial lead implantation at these sites was achieved in all these patients. Isolated sinus node activity without conduction to the atria was found in one patient.Conclusion Partial atrial standstill may be present and prevent atrial lead implantation in patients with sinus node disease. In these patients, recognition of partial atrial standstill and identification of surviving muscular islets with connection to the AV node by mapping studies may still allow synchronous AV sequential pacing.