title: Right atrial overdrive pacing for prevention of symptomatic refractory atrial fibrillation.
abstract: 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.
authors.affiliation: Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, The Netherlands.
authors.forename: Martin E W
authors.initials: ME
authors.lastname: Hemels
authors.forename: Ans C P
authors.initials: AC
authors.lastname: Wiesfeld
authors.forename: Bas
authors.initials: B
authors.lastname: Inberg
authors.forename: Pascal F H M
authors.initials: PF
authors.lastname: Van Dessel
authors.forename: Wiebe
authors.initials: W
authors.lastname: Nieuwland
authors.forename: Eng S
authors.initials: ES
authors.lastname: Tan
authors.forename: Henk
authors.initials: H
authors.lastname: Mulder
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Van Veldhuisen
authors.forename: Isabelle C
authors.initials: IC
authors.lastname: Van Gelder
mesh_terms: 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
chemical_list: D000889:Anti-Arrhythmia Agents