Bachmann's Bundle and Coronary Sinus Ostial Pacing Accentuate Left Atrial Electrical Dyssynchrony in an Acute Canine Model

• DOI: 10.1111/jce.12511
• Publication Date: 2014-08-11T13:22:53Z
• Authors: INDRAJIT CHOUDHURI; DAVID KRUM; ANUJ AGARWAL; JOHN HARE; MAREK BELOHLAVEK; ABDUR AHMAD; MAMATHA PINNINTI; BIJOY K. KHANDHERIA
• Keywords: atrial pacing; activation dispersion; Body Surface Potential Mapping; Cardiac Pacing, Artificial; Coronary Sinus; 03 medical and health sciences; Dogs; Treatment Outcome; 0302 clinical medicine; electrical activation sequence; Heart Conduction System; Acute Disease; Atrial Fibrillation; Animals; Heart Atria; resynchronization

In patients with intraatrial conduction delay and sinus node (SN) dysfunction, pacing Bachmann's bundle (BBR) coronary ostium (CSO) has been suggested to achieve atrial resynchronization potential beneficial impact on fibrillation diastolic heart failure. Clinical studies have not shown superiority of one approach.We studied electrical activation sequence in an open-chest acute canine model normal function 8 mongrel dogs under general anesthesia. Bipolar plunge electrodes were distributed over the surface atria during unifocal pacing, intracardiac was observed. SN resulted near-simultaneous at midline sites (BBR CSO); left atrium (LA) activated by anterior posterior wavefronts simultaneously propagating septally laterally meeting low-lateral perimitral LA. Right appendage (RAA) created intra-RA delayed onset LA activation. Pacing from RAA, CSO, BBR nonsimultaneous produced anteroposterior gradient This phenomenon seen greatest degree shifted site latest away all configurations except pacing.Pacing-induced intra-LA dispersion is enhanced secondarily shifts lateral mitral annulus. Measuring times can underestimate dyssynchrony be misinterpreted as synchrony. Establishing clinical requires evaluation human data.