Placement of atrial pacing leads during atrial fibrillation - Feasibility and subsequent lead performance

Aims To assess the feasibility of placing permanent atrial pacing leads dur ing atrial fibrillation (AF) and whether such leads function satisfactorily . Methods and Results Prospective study of 17 consecutive patients in whom pe rmanent atrial leads were positioned during an episode of paroxysmal AF. Fl uoroscopic position ('figure of 8' or side-to-side movement and anterior po sition in RAO projection), lead impedance (>300 but <1000 ohms) and intraca rdiac electrogram (average peak to peak amplitude >1 mV) were used to defin e an acceptable lead position. At 8 weeks post implant we measured: pulse d uration pacing threshold at 5 V; lead impedance at 5 V and 0.5 ms; intracar diac electrogram (EGM) signal amplitude. At the end of the study we reviewe d patients to establish whether AF had become permanent. In all patients, follow-up demonstrated satisfactory lead function. All lea ds had impedances between 300 and 1000 ohms. Pacing thresholds were all <0. 1 ms at 5 V. Mean atrial EGM amplitude seen in sinus rhythm was 3.3 mV (ran ge 1.2-8.4); in patients where all follow-up was in AF it was 2.1 mV (range 1.5-2.5). Nine patients (53%) developed permanent AF. Conclusion Placing atrial leads during AF is feasible using the technique d escribed. However, some patients progress to chronic AF, eliminating the be nefits of atrial pacing.