Right atrial overdrive pacing for prevention of symptomatic refractory atrial fibrillation.
OBJECTIVE
Our aim was to investigate whether right atrial overdrive pacing is effective for the prevention of atrial fibrillation (AF) in patients without bradyarrhythmias.


RESULTS
Patients with symptomatic paroxysmal or persistent AF refractory to at least two Class I or III antiarrhythmic drugs and without bradyarrhythmias were included. Successful therapy was defined as the combination of (a) a reduction of AF burden with or without AAD use >75%, (b) total AF burden < or =5% per year, and (c) less than one electrical cardioversion per year. Lower rate was set at 70 b.p.m. Additional AF prevention and termination features were used in case of no success. After a median follow-up of 18 (10-55) months, therapy was effective in 19 of the 36 included patients (53%). In 74% of the successfully treated patients, additional antiarrhythmic drugs were used. In successfully treated patients, the AF burden was reduced from 15% (5-100%) to 0% (0-4%). Multivariate analysis showed that the concomitant use of a Class I or III antiarrhythmic drug, a lower AF burden before implantation and the use of an angiotensin converting enzyme inhibitor were predictors of successful therapy.


CONCLUSIONS
Right atrial overdrive pacing in combination with antiarrhythmic drugs seems an attractive treatment option in drug refractory symptomatic AF patients.
Hemels
Martin E W
ME
Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, The Netherlands.
Wiesfeld
Ans C P
AC
Inberg
Bas
B
Van Dessel
Pascal F H M
PF
Nieuwland
Wiebe
W
Tan
Eng S
ES
Mulder
Henk
H
Van Veldhuisen
Dirk J
DJ
Van Gelder
Isabelle C
IC
D000368:Aged; D000465:Algorithms; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000517:prevention & control*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004554:Electric Countershock; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011237:Predictive Value of Tests; D016896:Treatment Outcome; D014463:Ultrasonography
D000889:Anti-Arrhythmia Agents