Role of high frequency atrial pacing for the termination of acute atrial fibrillation and atypical atrial flutter.
BACKGROUND
The aim of this study was to assess the efficacy of high-frequency (HF) pacing from the right atrial appendage (RAA) or coronary sinus ostium (CS-Os) for the termination of acute atrial fibrillation (AF) and atypical atrial flutter (AAFL) during an electrophysiological (EP) study.


METHODS
128 episodes of acute fast atrial arrhythmias (FAAs; 93 AF and 35 AAFL) were analyzed in 110 patients. Patients were initially observed for 60s leading to spontaneous termination of 28 FAAs. The remaining 100 FAAs (70 AF) episodes were randomized to the following strategies: (A) pacing at RAA using up to 10 consecutive 20-Hz trains followed by the same stimulation protocol at CS-Os if RAA pacing failed, (B) pacing at CS-Os using the same stimulation protocol followed by HF pacing at RAA, or (C) observation up to 6 minutes ("no pacing").


RESULTS
The 20-Hz pacing at both RAA and CS-Os was associated with higher conversion of AAFL, as compared to strategy C (60% and 77% vs 11%; P < 0.05). Only HF pacing at CS-Os was superior to observation strategy for the conversion of AF (21% vs 4%; P < 0.05).


CONCLUSIONS
The 20-Hz pacing protocol is superior to observation strategy for interruption of either acute AF or acute AAFL episodes; however, its efficacy is higher in AAFLs. These results can be helpful for the termination of acute atrial tachyarrhythmias during EPstudy and should be further evaluated in patients with implantable devices capable of antitachycardia pacing.
Shlevkov
Nikolay
N
Russian Cardiology Research Center, Moscow, Russia.
Yang
Alexander
A
Schrickel
Jan Wilko
JW
Schwab
Joerg Otto
JO
Bielik
Helga
H
Lickfett
Lars
L
Bitzen
Alexander
A
Nickenig
Georg
G
Lüderitz
Berndt
B
Lewalter
Thorsten
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000628:therapy*; D001282:Atrial Flutter / Q000175:diagnosis / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D005260:Female; D006325:Heart Atria; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome