Long-Term Pervenous Atrial Pacing

Long-term pervenous right atrial pacing has been used in five patients with intact atrioventricular (A-V) conduction for the treatment of refractory ventricular arrhythmias in two subjects and marked sinus bradycardia in three, two of whom also had paroxysmal supraventricular arrhythmias. The pervenous method was used to avoid a thoracotomy, and atrial pacing was chosen over ventricular pacing to preserve the normal A-V contraction sequence. Reliable atrial pacing was established in four cases, but one patient required ultimate conversion to a ventricular system because of irregular atrial capture. The most constant pacing was achieved by using a curved electrode with the tip positioned in the right atrial appendage.