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  • Title: Pacing to prevent atrial fibrillation.
    Author: Israel CW, Hohnloser SH.
    Journal: J Cardiovasc Electrophysiol; 2003 Sep; 14(9 Suppl):S20-6. PubMed ID: 12950513.
    Abstract:
    INTRODUCTION: Pacing has been proposed as a nonpharmacologic treatment option to prevent atrial tachyarrhythmias (ATs) in drug-refractory patients. This article reviews the current state of pacing to prevent ATs. METHODS AND RESULTS: Different pacing modalities have been assessed with regard to their ability to prevent AT: conventional DDDR pacing with elevated lower rate limit, biatrial pacing, dual-site right atrial pacing, atrial septal pacing, and pacing with the use of dedicated pacing algorithms. Small studies suggest a benefit of conventional pacing for AT prevention in patients with bradycardia, but a randomized trial did not reveal any AT reduction by conventional pacing in patients without bradycardia. AT prevention by biatrial or dual-site right atrial pacing has been reported in small studies, but randomized trials did not show a clear benefit of these pacing techniques. Small studies showed a reduced AT recurrence rate in patients with septal pacing at the triangle of Koch or at Bachmann's bundle. Two large randomized trials with preventive pacing algorithms showed a significant AT reduction compared to conventional pacing, but this was not confirmed in four trials. CONCLUSION: Pacing seems to be able to suppress ATs in a minority of patients; however, prospective identification of responders to different pacing modalities does not appear to be feasible at the present time.
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