Objectives: The aims of our study were to define the spatial extension of local atrial pacing capture (LAPC) in the right lateral atrial wall and to verify the effects of antiarrhythmic drugs on capture extension.
Background: Recently, LAPC during spontaneous chronic atrial fibrillation (AF) has been demonstrated directly in humans, but no systematic attempt has been made to evaluate its spatial extension.
Methods: The study was conducted in 14 consecutive patients with chronic AF, nine of whom were taking antiarrhythmic drugs. A Franz catheter for pacing and monophasic action potential recording was positioned in the lateral right atrial wall. An octopolar recording lead was positioned about 10 mm apart. The presence of atrial capture and its extension (number of captured bipolar pairs) were evaluated during decremental pacing.
Results: Forty-eight atrial capture attempts were made. LAPC was achieved in all the performed attempts. The AF types immediately before capture were type 1 in 35 (73%) and type 2 in 13 (27%) episodes. In 32 episodes, the capture was lost within 15 seconds and in the remaining 16 pacing was stopped after 15 seconds of stable capture. In 26 episodes, capture extended radially up to 4 cm from the pacing site, in 18 up to 3 cm, in 3 up 1 cm and in 1 up 1 cm. The mean extension in patients being treated with antiarrhythmic drugs was significantly greater than what was seen in untreated patients (3.8 +/- 0.4 vs 2.9 +/- 0.7 cm, p < 0.00001). Capture loss was less frequently observed when all four of the bipolar recording sites had been captured (13/25, 52% vs 19/23, 82%, respectively, p = 0.05).
Conclusions: LAPC in the lateral right atrial wall extends over a radius of 30-40 mm in the majority of capture episodes and is greater in patients treated with antiarrhythmic drugs. Our results suggest that, at least theoretically, simultaneous multisite pacing could be used to terminate AF. Moreover, a reduction in the atrial defibrillation threshold could be expected performing low-energy internal cardioversion during LPC.