Posibilities of cardiac pacemaker use in paroxsysmal atrial fibrilation

  • Borut Kamenik
Keywords: atrial fibrilation, heart electrostimulation, indications, anticoagulant therapy


Background: Prevention of atrial fibrillation is a big therapeutic challenge because of all known negative consequences of this the most frequent cardiac arrhythmia. Numerous of clinical studies showed bad control or ineffectiveness of antiarhythmic drugs. Nonfarmakological therapies like surgical treatment, radiofrequency ablation and atrial pacing are being tested. Effectiveness of atrial pacing in prevention of paroxysmal artial fibrillation has been documented in numerous prospective studies and is effective for a long time interval, but only for patients with bradicardic underlying cardiac rhythm. In Normocardic rhythm or normal AV conduction the effective Atrial fibrillation prevention was not proven. The mechanism of action is based on premature atrial complex suppression, reduction of dispersion of refractoriness after short-long cycles and reduction of interatrial conduction delay. The atrial stimulation site or multi-site atrial pacing could be effective in AF prevention when interatrial conduction delay is present; otherwise the difference is not significant.

Conclusions: In bradicardic patient who has frequent paroxysms of atrial fibrillation, regardless if bradycardia is due to ineffective antiarrhythmic drug treathement, implantation of DDDR pacemaker with atrial prevention algorhythm is indicated. If the P-wave duration is >120 milliseconds multi-site atrial pacing or septal atrial pacing should be considered. Pacemaker diagnostic tools could be used for adequate start of anticoagulant therapy and control of effectiveness of anthyarhythmic drug therapy.


Download data is not yet available.


Kannel WB, Abott RD, Savage DD, McNamara PM. Epidemiologic features of chronic atrial fibrilation: The Framingham study. N Engl J Med 1982; 306: 1018–22.

Juul-Moller S, Edvardsson N, Rehnqvist-Ahlberg N. Sotalol versus quinidine for maintenance of sinus rhythm after direct current conversion of atrial fibrilation. Circulation 1990; 82: 1932–9.

Gosselnik ATM, Crijns HJGM, Van Gilst WH, et al. Low-dose amiodarone for maintenance of sinus rhythm after cardioversion of atrial fibrilation or flutter. JAMA 1992; 267: 3289–96.

Roy D, Talajic M, Dorian P, et al. Amiodarone to prevent recurrence of atrial fibrilation. Canadian Trial of Atrial Fibrillation Investigators. N Engl J Med 2000; 342: 913–20.

Rosenqvist M, Brandt J, Schuller HI. Long-term pacing in sinus node disease: effects of stimulation mode on cardiovascular morbidity and mortality. Am Heart J 1988; 116: 16–22.

Santini M, Alexidou G, Ansalone G, Cacciatore G, Cini R, Turitto G. Relation of prognosis in sick sinus syndrome to age, conduction defects, and modes of permanent pacing. Am J Cardiol 1990; 65: 729–35.

Sgarbossa EB, Pinski SL, Maloney JD, Simmons TW, Wilkoff BL, Castle LW, Trohman RG. Chronic atrial fibrilation and stroke in paced patients with sick sinus syndrom: relevance of clinical characteristics and pacing modalities. Circulation 1993; 88: 1045–53.

Andersen HR, Nielsen JC, Thomsen PEB, et al. Long-term follow-up of patients from a randomised trial of atrial versus ventricular pacing for sicksinus syndrome. Lancet 1997; 305: 1210–104.

Lamas GA, Orav EJ, Stambler BS, et al. for the Pacemaker Selectioning the Elderly Investigators. Quality of life and clinical outcomes in elderly patients treated with ventricular pacing as compared with dual-chamber pacing. N Eng J Med 1998; 338: 1097–104.

Gillis AM, Wyse DG, Connlloy SJ, Dubuc M, Philippon F, Yee R, et al. for Atrial Pacing Periablation for Paroxysmal Atrial Fibrilation (PA3) Study Investigators. Atrial pacing periablation for prevention of paroxysmal atrial fibrilation. Circulation 1999; 99: 2553–8.

Saksena S, Prakash A, Hill M, Krol RB, Munsif AN, Mathew PP, Mehra R. Prevention of recurrent atrial fibrilation with chronic dual-site right atrial pacing. J Am Coll Cardiol 1996; 28: 687–94.

Delafaut P, Saksena S, Prakash A, Krol RB. Long-therm outcome of patients with drug-refractory atrial flutter and fibrilation after single- and dual-site right atrial pacing for arrhytmia prevention. J Am Coll Cardiol 1998; 32: 1900–8.

Levy T, Walker S, Rochelle J, Paul V. Evaluation of biatrial pacing, right atrial pacing, and no pacing in patients with drug refractory atrial fibrilation. Am J Cardiol 1999; 84: 426–29.

Daubert C, Mabo PH, Berder V, Gras D, Leclercq C. Atrial tachyarrhythmias associated with high degree interatrial conduction block: prevention by permanent atrial resynchronisation. Eur JCPE 1994; 35: 35–44.

Lam CTF, Lau CP, Leung SK, et al. Efficacy and tolerability of continuous overdrive atrial pacing in atrial fibrilation. Europace 2000; 2: 286–91.

Ricci R, Santini M, Puglisi A, et al. Impact of consistent atrial pacing algorithm on prematural atrial complex number and paroxsysmal atrial fibrillation recurrences in brady-tachy syndrome: a randomized prospective cross over study. J Interv Card Electrophysiol 2001; 5: 33–44.

Mehra R. Prevention of atrial fibrilation/flutter by pacing tehniques. In: Saksena S, Luderitz B, eds. Interventional electrophysiology: A textbook. 2nd ed. Armonk, NY: Futura Publishing Co. 1996. p. 521–40.

Han J, Millet D, Chizzonitti B, Moe GK. Temporal dispersion of recovery of excitability in atrium and ventricle as a function of heart rate. Am Heart J 1996; 71: 481–7.

Murgatroyd FD, Nitzsche R, Slade AK, et al. A new pacing algorithm for overdrive suppression of atrial fibrilation. Pacing Clin Electrophysiol 1994; 17: 1966–73.

Ravelli F, Allesie M. Effects of atrial dilatation on refractory period and vulnerability to atrial fibrilation in isolated Langendorff-perfused rabbit heart. Circulation 1997; 96: 1686–95.

Skanes AC, Krahn AD, Yee R, et al. for the CTOPP Investigators. Progression to chronic atrial fibrilation after pacing: the Canadian Trial of Physiologic Pacing. J Am Coll Cardiol 2001; 38: 167–72.

Daubert C, Mabo PH, Berder V, et al. Atrial tachyarrhythmias associated vith high degree interatrial conduction block: prevention by permanent atrial resinhronisation. Eur J Cardiac Pacing Electrophysiol 1994; 1: 35–44.

D’Allonnes GR, Pavin D, Leclercq C, et al. Long-term effect of biatrial synchronous pacing to prevent drug-refractory atrial tachyarrhythmia: a 9-year experiance. J Cardiovasc Electrophysiol 2000; 11: 1081–91.

Bailin SJ, Adler S, Giudici M. Prevention of chronic atrial fibrilation by pacing in the region of Bachmann’s bundle: results of a multi-center randomized trial. J Cadriovasc Elecrophysiol 2001; 12: 912–7.

Padeletti L, Pieragnoli P, Ciapetti C, et al. Randomized cross-over comparison of right atrial appendage pacing versus interatrial septum pacing for prevention of paroxysmal atrial fibrillation in patients with sinus bradycardia. Am Heart J 2001; 142: 1047–55.

Crystal E, Connolly SJ, Sleik K, et al. Interventions on prevention of postoperative atrial fibrillation in patients undergoing heart surgery. A metaanalysis. Circulation 2002; 106: 75–80.

Lee MA, Weachter R, Pollak S, et al. For the ATTEST Investigators. The effect of atrial pacing therapies on atrial tachyarrhythmia burden and frequency. Y Am Coll Cardiol 2003; 41: 1926–32.

Saksena S, Prakash A, Ziegler P, et al. For the DAPPAF Investigators. Impruved suppression of recurrent atrial fibrilation with dual-site right atrial pacing and antiarrhythmic drug therapy. J Am Coll Cardiol 2002; 40: 1140–50.

How to Cite
Kamenik B. Posibilities of cardiac pacemaker use in paroxsysmal atrial fibrilation. ZdravVestn [Internet]. 1 [cited 27May2019];74. Available from: https://vestnik.szd.si/index.php/ZdravVest/article/view/2186
Test Section