Long-term Prevention of Vagal Atrial Arrhythmias by Atrial Pacing at 90/Minute: Experience with 6 Cases (original) (raw)
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Clinical Observations with Long-term Atrial Pacing
Pacing and Clinical Electrophysiology, 1998
B6HM, A., ET AL.: Clinical Observations with Long-term Atriai Pacing. Atriai pacing (AP), despite its beneficial hemodynamic and antiarrhythmic effect, is still an underused mode of stimulation. The main purpose of this study was to evaluate the long-term results ofAP. Sixty four patients (pts) with sinus node disease (28 male and 36 female: mean age 54,2; range:44-88 years), 3,2% of the total implantation at our clinic were treated with AP between 1982-96. Criteria for atriai pacing were: no AV block in the history, no AV-block during carotid sinus massage, Wenckebach point>130/min, left atrium<50mm, left ventricular EF>40%. The indication for pacing was predominant sinus bradycardia (SB) in 34 pts and tachycardia-bradycardia syndrome (TBS) in 30 pts. Pts with TBS were on antiarrhythmic treatment, while most pts with SB received no antiarrhythmic drugs. All the pts were checked up at every 3-6 month. Sixty-two pts were followed for 3-154 (mean: 67) months, two pts were lost for follow-up. Repeated lead dislodgment occurred in two pts, which made a pacing mode change necessary. Four pts died during the follow-up period for non-cardiac reasons. At the end of the follow-up period the data of 60 pts were available for evaluation (33 pts with SB, 2 7 pts with TBS). A ll the pts with SB were in sinus rhythm, and no patient developed A V block by the end of the follow-up period Seven out of 27 pts with TBS developed chronic atriai fibrillation, 3 out of them suffered a cerebral embolism; the remaining 20 pts were in sinus rhythm, and the number of paroxysmal attacks decreased significantly, which improved their quality of life significantly. Three pts in this group developed a temporary complete AV block, which regressed with decreasing the dosage of antiarrhythmic drugs. Atriai pacing is proved to be a safe and reliable treatment for sick sinus syndrome. Proper patient selection is crucial in preventing the development of AV conduction disturbance. Atriai stimulation had a satisfactory long-term antiarrhythmic effect in pts with sick sinus syndrome (SSS). atriai pacing, sick sinus syndrome, long-term foUow-up
Revista Portuguesa de Cardiologia (English Edition), 2014
Introduction: The aim of this study was to assess the effectiveness of atrial antitachycardia pacing (ATP) in the conversion of atrial tachyarrhythmia episodes, and its impact in reducing arrhythmic burden. Methods: We performed a retrospective study in the pacing laboratory of a district hospital of 57 consecutive patients implanted with a dual chamber pacemaker, capable of performing atrial antitachycardia pacing, between 2005 and 2010. The patients were divided into two groups: ATP ON (n=24) and ATP OFF (n=33). The follow-up period was 15 months, with data being collected at three follow-up consultations: the first at three months after implantation, the second at nine months and the last at 15 months. In this period, there were 12 428 ATP therapies of atrial tachyarrhythmias. Results: Although there were no statistically significant differences, there was a trend in favor of the ATP ON group, the increase in arrhythmic burden being less marked in this group. The mean percentage of ventricular apical pacing was also significantly lower in this group, which was associated with a marginally significant reduction in arrhythmic burden (p=0.06). There was a significant positive correlation between changes in the percentage of ventricular pacing and changes in arrhythmic burden (r=0.417, p=0.02).
International Journal of Cardiology, 1993
The incidence of atrioventricular (AV) block and chronic atria1 flutter/fibrillation was determined in 41 patients, mean age 62.2 years (22 to 88 years) who received atria1 pacemakers before October 1980. The mean follow-up period was 12.3 years, range 11-14.4 years. Twenty-live patients suffered from bradycardia-tachycardia syndrome, 13 symptomatic bradycardia, and 3 bradycardia related ventricular tachycardia. At follow-up: 18 patients (44%) had permanent I-AV block; 11 patients had II-AV block, 9 patients (22%) transient Wenckebach block and 2 patients (5%) transient Mobitz block, all asymptomatic. The cumulative incidence of III-AV block was 1 (2.5%). Chronic atria1 flutter/fibrillation occurred in 6 patients (15%), 5 were not pacemaker-dependent; 1 received a ventricular pacemaker. Seventeen patients died after a mean of 7 years (0.6-12.2 years). Cumulative survival rate of 58% for 14.4 years, did not differ from a matched cohort of the normal population. There were no pacemaker related deaths. We conclude that long-term atria1 pacing was safe and effective. The incidence of III-AV block and chronic atria1 flutter/fibrillation was low.
Effect of atrial pacing on ventricular rate during atrial fibrillation. A human study
Journal of Cardiovascular Medicine, 2008
Objective This research study tests the hypothesis that atrial pacing near the atrioventricular node during atrial fibrillation can affect ventricular rate. Methods In 13 patients, two monophasic action potential catheters were advanced into the low anterior septum (ANT) and the low posterior septum (POST) near the atrioventricular node. After induction of atrial fibrillation, measurement of the excitable gap was attempted at the ANT and POST regions. During atrial pacing, ventricular cycle length (CL) at the longest excitable gap was compared to ventricular CL at the shortest excitable gap by pairwise analysis. Results Transient capture of ANT tissue during ANT pacing was observed in six patients, whereas transient capture of POST tissue during POST pacing was observed in four patients. The ventricular response to ANT and POST pacing at multiple rates was recorded in six and seven patients, respectively. An increase in POST pacing CL by 40 W 24 ms prolonged (P < 0.05) ventricular CL by 45 W 56 ms. Conversely, an increase in ANT pacing CL by 48 W 42 ms shortened (P < 0.05) ventricular CL by 45 W 40 ms. Conclusions ANT and POST pacing CL affected ventricular CL during atrial fibrillation, even though capture was transient. The opposite direction of the effects of ANT and POST pacing CL on ventricular CL may indicate that the atrial impulses from the POST region are more likely to conduct to the ventricle than impulses from the ANT region as the CL of activation is decreased.
Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2000
The purpose of this study was to investigate if single lead interatrial septum pacing could be effective in maintaining sinus rhythm in patients in whom restoration of sinus rhythm was only possible for a period of 2-24 hours after one or more previous electrical cardioversions, and in whom a sinus bradycardia was documented before arrhythmia restarted. The two hours limit was chosen because it was considered a sufficient time to implant a dual chamber pacemaker. Alternative atrial pacing techniques have been demonstrated to be successful in preventing recurrences of atrial fibrillation (AF) in patients with sinus bradycardia. Excluding the AF occurring after only a few sinus beats, at 24 hours from electrical cardioversion an early restart of chronic AF has been reported in 12% to 17% of the patients. After sinus rhythm was restored by internal electrical cardioversion, 17 patients, 7 ablated at the AV junction, underwent a dual chamber rate response (DDDR) pacemaker implantation w...
Pacing to Prevent Atrial Fibrillation
Journal of Cardiovascular Electrophysiology, 2003
Atrial Preventive Pacing. Introduction: Pacing has been proposed as a nonpharmacologic treatment option to prevent atrial tachyarrhythmias (ATs) in drug-refractory patients. This article reviews the current state of pacing to prevent ATs.
Prevention of paroxysmal atrial fibrillation by permanent septal atrial pacing: long-term follow up
European Heart Journal Supplements, 2001
Background Inter-atrial septum pacing may prevent initiation or persistence of atrial fibrillation through suppression of premature beats and regularization of atrial rhythm; prolongation of the coupling interval of the premature beats in the abnormal substrate; and modification of the electrophysiological properties of the substrate. The aim of the present study was to evaluate the rate of progression to permanent atrial fibrillation in patients paced at the inter-atrial septum.