title: Role of high frequency atrial pacing for the termination of acute atrial fibrillation and atypical atrial flutter.
abstract: 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.
authors: Russian Cardiology Research Center, Moscow, Russia.
authors: Nikolay
authors: N
authors: Shlevkov
authors: Alexander
authors: A
authors: Yang
authors: Jan Wilko
authors: JW
authors: Schrickel
authors: Joerg Otto
authors: JO
authors: Schwab
authors: Helga
authors: H
authors: Bielik
authors: Lars
authors: L
authors: Lickfett
authors: Alexander
authors: A
authors: Bitzen
authors: Georg
authors: G
authors: Nickenig
authors: Berndt
authors: B
authors: Lüderitz
authors: Thorsten
authors: T
authors: Lewalter
mesh_terms: 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