Prospective Within-Subject Evaluation of Immediate Electrophysiological Effects of Multiple Atrial Pacing Sites on Atrial Activation and P-Wave Morphology

What this Trial Is About

Researchers are investigating the immediate effects of pacing at different sites in the atrium during pacemaker implantation to understand how these sites influence atrial electrical activation. This study focuses on comparing P-wave characteristics on surface electrocardiography (ECG) to identify which atrial pacing site best preserves physiological conduction. The research is designed as a prospective, single-center, non-randomized interventional study involving patients indicated for permanent pacemaker implantation. During the procedure, short-term pacing will be performed sequentially at multiple predefined atrial sites including the right atrial appendage (RAA), atrial septum, Bachmann's bundle (BB) area, and posterosuperior bundle (PSB) regions at both high and low levels. The pacing at these sites will be conducted during routine pacemaker implantation, with PSB pacing maintained for the remainder of the procedure. ECG parameters such as P-wave duration, morphology, and polarity will be recorded at each pacing site to assess differences. Participants will undergo sequential atrial pacing at the specified sites during implantation, with simultaneous 12-lead ECG recordings to evaluate electrical activation patterns. Researchers will measure P-wave duration as the primary outcome and analyze P-wave morphology and polarity as secondary outcomes during the implantation. This approach aims to provide insights that could guide optimal atrial lead placement. The study is expected to conclude in October 2026, and participation involves the duration of the implantation procedure only.

Immediate Electrophysiological Effects of Different Atrial Pacing Sites on P-Wave Characteristics