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Effect of Right Atrial Overdrive Pacing in the Prevention of Symptomatic Paroxysmal Atrial Fibrillation:
Author(s) -
WIBERG STEFAN,
LÖNNERHOLM STEFAN,
JENSEN STEEN M.,
BLOMSTRÖM PER,
RINGQVIST IVAR,
BLOMSTRÖMLUNDQVIST CARINA
Publication year - 2003
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1046/j.1460-9592.2003.t01-1-00278.x
Subject(s) - medicine , atrial fibrillation , premature atrial contraction , cardiology , paroxysmal atrial fibrillation , heart rate , angina , anesthesia , cardiac pacing , blood pressure , myocardial infarction
The aim of this study was to assess if right atrial overdrive pacing can suppress symptomatic episodes of paroxysmal atrial fibrillation (PAF) in patients without bradyarrhythmias. Forty‐two patients with frequent and symptomatic PAF without other pacing indication had a pacemaker implanted after a 4‐week run‐in period, during which the frequency of symptomatic PAF episodes and the mean heart rate were objectively documented. Depending on the mean heart rate recorded during run‐in, the pacemaker was programmed in random order to right atrial AAI pacing at 10–19 beats/min > mean heart rate (medium overdrive [MO]), at 20–29 beats/min > mean heart rate (high overdrive [HO]) and to no pacing (OAO mode) for 4–12 weeks each using a crossover design. In the 35 patients who completed the protocol, the number of symptomatic episodes of PAF (>30‐second duration) per week was significantly lower during MO pacing (median 0.88, P = 0.001, n = 35) and during HO pacing (median 0.75, P = 0.002, n = 20) than during OAO (median 2.02 and 2.04, respectively). There was no difference between MO and HO pacing in the 20 patients paced at both rates (0.97 vs 0.75, P = 0.33). Seven patients did not complete the protocol due to persistent atrial fibrillation (n = 4), angina pectoris requiring surgery (n = 1), and unwillingness to continue the study due to improvement (n = 1) or worsening (n = 1) of symptoms during the study periods. Right atrial overdrive pacing can reduce the number of symptomatic PAF episodes in patients with frequent and drug refractory PAF but without bradyarrhythmias. (PACE 2003; 26:1841–1848)