title: Pacing for the suppression of paroxysmal atrial fibrillation in an 87-year-old patient.
abstract: BACKGROUND
  Sinus node dysfunction, atrioventricular (AV) block and atrial fibrillation (AF) are associated with advanced age. Required therapy commonly includes pacemaker implantation.
  
  
  METHODS
  We report the course of therapy for an 87-year-old with symptomatic sinus node dysfunction and paroxysmal atrial fibrillation who was intolerant of drug therapy.
  
  
  RESULTS
  The patient received a pacemaker for treatment of sick sinus syndrome. She continued to have symptomatic episodes of AF and was intolerant of pharmacologic therapy despite adequate rate support provided by the pacemaker. The AF suppression algorithm in the pacemaker was enabled, resulting in the elimination all AF episodes effectively eliminating the need for antiarrhythmic medication. If this continues to stabilize her atrium, withdrawal of anticoagulation therapy is anticipated.
  
  
  CONCLUSIONS
  The clinical presentation of sinus node dysfunction and related conduction abnormalities is common in the elderly. Pharmacologic management is often a challenge in the presence of the advanced age and concomitant disease processes. In individuals who have paroxysmal atrial fibrillation or are likely to develop this and who need a pacemaker for standard indications, the availability of an AF Suppression algorithm may facilitate their management without needed to use medications or being able to utilize lower doses of those medications.
authors.affiliation: Section of Cardiology, Olive View Medical Center, 14445 Olive View Drive, Sylmar CA 91342, USA. plevine@sjm.com
authors.forename: Paul A
authors.initials: PA
authors.lastname: Levine
authors.forename: Robin
authors.initials: R
authors.lastname: Wachsner
authors.forename: Adel
authors.initials: A
authors.lastname: El-Bialy