Pacing to prevent atrial fibrillation.
BACKGROUND
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.


RESULTS
Different pacing modalities have been assessed with regard to their ability to prevent AT: conventional DDDR pacing with elevated lower rate limit, biatrial pacing, dual-site right atrial pacing, atrial septal pacing, and pacing with the use of dedicated pacing algorithms. Small studies suggest a benefit of conventional pacing for AT prevention in patients with bradycardia, but a randomized trial did not reveal any AT reduction by conventional pacing in patients without bradycardia. AT prevention by biatrial or dual-site right atrial pacing has been reported in small studies, but randomized trials did not show a clear benefit of these pacing techniques. Small studies showed a reduced AT recurrence rate in patients with septal pacing at the triangle of Koch or at Bachmann's bundle. Two large randomized trials with preventive pacing algorithms showed a significant AT reduction compared to conventional pacing, but this was not confirmed in four trials.


CONCLUSIONS
Pacing seems to be able to suppress ATs in a minority of patients; however, prospective identification of responders to different pacing modalities does not appear to be feasible at the present time.
Israel
Carsten W
CW
Department of Medicine, J.W. Goethe University Hospital, Frankfurt, Germany.
Hohnloser
Stefan H
SH
D000465:Algorithms; D001281:Atrial Fibrillation / Q000517:prevention & control*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002986:Clinical Trials as Topic / Q000379:methods*; D019317:Evidence-Based Medicine / Q000379:methods*; D006801:Humans; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D013813:Therapy, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome