The effect of anti-tachycardia atrial pacing in patients with recurrent paroxysmal atrial fibrillation

Background: Atrial fibrillation (AF) is an arrhythmia with complex pathophysiological characteristics. The efficiency of various anti-tachyarrhythmic stimulation algorithms in patients with recurrent AF has become a subject of research and the aim of this analysis is to evaluate the success of treatment by continuous DDD(R) stimulation with an anti-tachyarrhythmic pacing algorithm in patients with paroxymal AF. Methods: In the period 2002–2004 19 patients (10 females and 9 males), aged 45–74 (with a mean age of 64.2 ± 7.6), qualified for DDD(R) system implantation. The indication for implantation was tachy-brady syndrome with recurrent AF resistant to pharmacological treatment. All the patients had had at least three recurrences of symptomatic AF within the previous year. The follow-up period was 12 months. AF recurrences, outpatient visits and hospitalisation frequency were evaluated every 6 months and there were routine pacemaker controls. Baseline and final visit echocardiograms and a quality of life (QoL) questionnaire (SF-36) were obtained. Results: One patient was excluded from the analysis owing to permanent AF with a final VVI pacing mode. In comparison with the pre-inclusion 12 months AF-related hospitalisation frequency within the 12-month follow-up period was 3.9 vs. 0.4 (p < 0.005) and outpatient visits 2.1 vs. 0.8 (p < 0.05). The mean atrial pacing percentage in all patients was 95.7% ± ± 2.9%, and the mode switch percentage during the first and second 6 month periods was 6.4% (1–50%, median 2) and 2.5% (0–7, median 2, NS) respectively. There were 483/month (0.44–5761, median 31) events defined as AF episodes during first 6 months and 84/month (0–480, median 17, NS) during the second 6 months. The AF burden was 1.92 days/month (7 h – 15 days, median 14 h), decreasing to 0.74 day/month (0–2.1 days, median 14 h, NS) in the second 6-month period. A significant 12-month improvement was achieved in QoL parameters. Conclusions: An overdrive atrial algorithm can be a beneficial, safe and comfortable method in patients with paroxysmal drug-resistant AF and accepted indications for physiological pacing. (Folia Cardiol. 2006; 13: 590–595)