Permanent Left Atrium Pacing via Coronary Sinus

概要

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Atrial pacing is effective in sick sinus patients. In high threshold right atrium, however, atrial pacing is difficult. Left atrium muscle exists around coronary sinus. Left atrium pacing is enabling via coronary sinus. Patients: From 2008 to 2010, four SSS patients and two A-V block patients received permanent left atrium pacing via coronary sinus. There were three men and three women. Patient’s mean age was 67 years old (43–83). One patient was post MVR. Other patient became reoperation since atrial lead placed upper atrial septum was floated. <B>Methods and Results:</B> Pacing lead was placed via left subclavian vein with cut down technique. Screw-in lead was used. First right atrium upper septum was attempted, next right atrium appendage, finally lower septum or coronary sinus. Lead placed site was proximal position in 5 patients and distal in one patient. Atrial threshold is 0.5–1.25 V at proximal and 3 mV at distal. Atrial sensing is 0.5–4.3 mV. Lead impedance is 464–583 Ω. Post operative chest lateral Xp showed atrial lead in coronary sinus. Negative P wave was showed in ECG 2 lead. There were no complications of infection, coronary sinus thrombosis, hemorrhage, or trauma. All patients alive and DDD pacing was maintained at last examination. <B>Conclusion:</B> Left atrium pacing via coronary sinus is a safe and feasible technique.