Comments

• the conventional site for atrial pacing is the right atrial appendage because it is an easily accessible and stable location
• when the atrial lead is positioned at the appendage, the chest X-ray shows an inferiorly directed lead into the right atrium, with an anterior curve (“J loop”)
• pacing from the right atrial appendage in patients with pathological atrial myocardium prolongs the intra-atrial/inter-atrial conduction time and may increase the risk of atrial fibrillation
• alternative pacing sites within the right atrium (Bachmann’s bundle, interatrial septum, ostium of the coronary sinus or multiple atrial sites) have been investigated to prevent the occurrence of atrial fibrillation
• despite initial promising results with significant reduction of the total atrial activation time, the value of septal pacing or biatrial pacing in preventing atrial fibrillation has not been clearly demonstrated
• the lateral atrial wall is usually avoided because of the increased risk of perforation and of phrenic nerve capture