Is There a Role for Pacing in the Prevention of Paroxysmal Atrial Fibrillation?

Introduction Atrial fibrillation (AF) is the most common significant cardiac arrhythmia, affecting an estimated four million people worldwide. Its rapid and uncoordinated atrial rhythm significantly compromises hemodynamics, decreases cardiac output, predisposes to ventricular arrhythmias, and sets the stage for thromboembolic complications. Contributing mechanisms are presumed to be the occurrence of long-short cycles, an increased temporal dispersion of refractoriness, and atrial ectopic activity serving as the trigger in the presence of an underlying substrate of progressive myocardial fibrosis, gap junction abnormalities and other changes on a cellular level [1] . The incidence of atrial fibrillation increases with age, affecting 4% of those over 60 and up to 15% of those over 70 [2,3] . Although atrial fibrillation can occur in the absence of other conditions ("lone" AF), it is most often associated with a number of complicating conditions, including hypertension, valvular heart disease, coronary artery disease and others.