Diagnostic and therapeutic uses of atrial pacing.

There are occasions when atrial pacing can be usefully employed both diagnostically and therapeutically. Diagnostically, atrial pacing provides mechanisms for easily, safely, and reproducibly stressing the heart that can help in the evaluation of patients with a variety of cardiac disorders. It is particularly useful in the assessment of patients with coronary disease. Therapeutically, atrial pacing has been applied in four general areas: (1) to terminate or slow supraventricular tachyarrhythmias; (2) to accelerate the heart rate in patients with sinus bradyeardia and intact atrioventricular conduction; (3) to suppress ventricular irritability; and (4) to augment cardiac output. Techniques of atrial pacing are discussed. Currently, a major problem with both temporary and long-term pervenous atrial pacing is erratic pacing. The development of electrodes and pacemakers designed specifically for atrial pacing, as well as further experience with stimulation from the coronary sinus may lead to more reliable pacing.