title: Atrial burst pacing with biphasic and monophasic waveforms for atrial fibrillation.
abstract: BACKGROUND
  Biphasic pacing is a novel mode of pacing that was suggested to increase cardiac conduction velocity as compared with cathodal monophasic pacing. We aimed to evaluate the safety and efficacy of rapid atrial pacing to convert atrial fibrillation (AF) to normal sinus rhythm.
  
  
  METHODS
  Multiple biphasic (anodal/cathodal), reverse biphasic (cathodal/anodal), and monophasic (cathodal) atrial pacing therapies were performed among 12 patients undergoing left atrial catheter ablation for AF. The efficacy end point was successful conversion of AF to sinus rhythm, and safety end point no induction of ventricular arrhythmias. Patients were paced at three cycle lengths (100, 200, and 333 msec) for 60 seconds at three locations (right and left atrial appendages and coronary sinus).
  
  
  RESULTS
  Among the 66 biphasic (anodal/cathodal) pacing procedures one procedure in a patient with chronic AF, which involved pacing at the left atrial appendage with a cycle length of 200 msec, led to conversion of AF to sinus rhythm. None of the 66 monophasic pacing procedures or the 66 reverse biphasic (cathodal/anodal) pacing procedures was associated with AF termination. None of the biphasic pacing procedures was associated with induction of ventricular arrhythmias.
  
  
  CONCLUSIONS
  Rapid atrial pacing using a variety of waveforms at the cycle length and output used in the current study was found to be safe. There was a single success in converting a chronic AF to sinus rhythm.
authors.affiliation: Cardiology Division, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Alon
authors.initials: A
authors.lastname: Barsheshet
authors.forename: Menachem
authors.initials: M
authors.lastname: Wakslak
authors.forename: Morton M
authors.initials: MM
authors.lastname: Mower
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.forename: Burr
authors.initials: B
authors.lastname: Hall
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D022062:Electrophysiologic Techniques, Cardiac; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D013318:Stroke Volume