“Atrio-atrial pacing” as a treatment for electrical dissociation after catheter ablation

Excerpt

A patient with a history of surgical repair for an anomalous pulmonary venous connection was admitted for recurrent atrial tachycardias (ATs). To treat the ATs, ablation lesions were applied between the superior and inferior vena cava (SVC and IVC), between the IVC and tricuspid annulus (TA) and near the anterior SVC and TA (white lines in Fig. 1). This unintentionally led to a dissociation of electrical activity between the lateral and septal parts of the right atrium with symptomatic bradycardia and asystolic episodes. A dual-chamber pacemaker was implanted to work as an electrical “bypass”—one atrial lead was positioned in the right atrial appendage (RAA) for sensing and another lead was implanted in the right atrial septum (RA septum) for “atrio-atrial pacing” (Fig. 2a). An AV delay was programmed to a fixed minimum value of 15 ms. At the 12-month follow-up, we documented 100 % RA septal pacing (Fig. 2b). Even though inadvertent interatrial electrical dissociation after ablation has been described [1], this is the first case utilizing a dual-chamber pacemaker as a “bypass” connecting the two electrically isolated areas.

…