title: Management of atrial fibrillation in bradyarrhythmias.
abstract: Sinus node disease (SND), a common indication to implant a pacemaker, is frequently associated with atrial fibrillation (AF), either at implantation (paroxysmal AF) or during follow-up, which often evolves to persistent or permanent AF. Pacemakers with an atrial lead allow continuous monitoring of the atrial rhythm and enable detection of the burden of AF. Asymptomatic atrial tachyarrhythmias, being associated with increased risk of stroke, have important prognostic implications, and their detection could guide decision-making about antithrombotic prophylaxis. Pacing mode and pacing algorithms can influence the occurrence of AF and atrial tachyarrhythmias. In DDD/DDDR pacing mode, reduction of unnecessary right ventricular pacing positively affects the occurrence and evolution of AF, but patients with a history of atrial tachyarrhythmias maintain an increased risk of arrhythmic events. In the MINERVA study, the use of algorithms that act in the atrium for preventive pacing and atrial antitachycardia pacing while minimizing right ventricular pacing was beneficial in patients with SND and previous atrial tachyarrhythmias, and was associated with a significant reduction in evolution to permanent AF. New information available on therapies delivered at the atrial level by implanted devices suggests clinical advantages that could improve current guidelines for the management of AF and atrial tachyarrhythmias.
authors.affiliation: Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138 Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
authors.affiliation: Institute of Internal Medicine and Cardiology, University of Florence, Viale Morgagni 85, 50134 Florence, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Padeletti
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D001919:Bradycardia / Q000150:complications*; D002304:Cardiac Pacing, Artificial / Q000379:methods; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D010138:Pacemaker, Artificial; D012804:Sick Sinus Syndrome / Q000150:complications / Q000628:therapy; D020521:Stroke / Q000209:etiology / Q000517:prevention & control
chemical_list: D005343:Fibrinolytic Agents