Pacing in Atrial Fibrillation: Is It Still Viable?

  • Oscar Oseroff
  • Gustavo Iralde
  • Enrique Retyk
Conference paper


Atrial fibrillation (AF) is one of the most intensively studied topics in the cardiology community due to its growing prevalence, its high morbidity and costs, and its expanding therapeutic options following new insights into the disease. The prevalence of AF is around 1% of the general population, and increases to up to 4% in the population over 65 years old. Similarly, the number of patients that need a pacemaker is constantly growing, and these patients have much in common with the AF population (elderly, coronary artery disease, heart failure). Thus, the number of patients with a combination of AF and pacemakers is increasing [1], [2].


Atrial Fibrillation Left Ventricular Ejection Fraction Cardiac Resynchronization Therapy Ventricular Pace Atrial Pace 
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  1. 1.
    Fuster V, Ryden LE, Cannom DS et al (2006) ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation). J Am Coll Cardiol 48(4):e149–e246CrossRefGoogle Scholar
  2. 2.
    Gregoratos G, Gibbons RJ, Antman EM et al (2002) ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 106:2145–2161PubMedCrossRefGoogle Scholar
  3. 3.
    Haissaguerre M, Jais P, Shah D et al (1998) Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 339:659–666PubMedCrossRefGoogle Scholar
  4. 4.
    Maurits A, Ausma J, Schotten U (2002) Electrical, contractile and structural remodeling during atrial fibrillation. Cardiovasc Res 54:230–246CrossRefGoogle Scholar
  5. 5.
    Waldo A (2003) Mechanism of atrial fibrillation. J Cardiovasc Electrophysiol 14:S267–S274PubMedCrossRefGoogle Scholar
  6. 6.
    Nattel S (2002) Therapeutic implications of atrial fibrillation mechanisms: can mechanistic insights be used to improve AF management? Cardiovasc Res 54:347–360PubMedCrossRefGoogle Scholar
  7. 7.
    Bennett MA, Pentecost BL (1970) The pattern of onset and spontaneous cessation of atrial fibrillation in man. Circulation 41:981–988PubMedGoogle Scholar
  8. 8.
    Solti F, Vecsey T, Kekesi V et al (1989) The effect of atrial dilatation on the genesis of atrial arrhythmias. Cardiovasc Res 23:882–886PubMedCrossRefGoogle Scholar
  9. 9.
    Capucci A, Groppi F, Ruiter J et al, on behalf of the AF Therapy Study Group (2000) Evaluation of re-initiation of atrial fibrillation through a pacemaker with focused diagnostics. Pacing Clin Electrophysiol 23:722 (abs)Google Scholar
  10. 10.
    Hoffmann E, Janko S, Hahnewald S et al (2000) The Atrial Fibrillation Therapy (AFT) trial: novel information on dominant triggers of paroxysmal atrial fibrillation. Circulation 102:II481–II482 (abs)Google Scholar
  11. 11.
    Santini M, Alexidou G, Ansalone G et al (1990) Relation of prognosis in sick sinus syndrome to age, conduction defects and modes of permanent atrial pacing. Am J Cardiol 65:729–735PubMedCrossRefGoogle Scholar
  12. 12.
    Andersen HR, Thuesen L, Baggar JP et al (1994) Prospective randomised trial of atrial versus ventricular pacing in sick-sinus syndrome. Lancet 344:1523–1528PubMedCrossRefGoogle Scholar
  13. 13.
    Skanes AC, Krahn AD, Yee R et al, for the CTOPP Investigators (2001) Progression to chronic atrial fibrillation after pacing: the Canadian Trial of Physiologic Pacing. J Am Coll Cardiol 38:167–172PubMedCrossRefGoogle Scholar
  14. 14.
    Lamas G, Lee K, Weeney M et al, for the Mode Selection Trial in Sinus-Node Dysfunction (2002) Ventricular pacing or dual chamber pacing for sinus node dysfunction. N Engl J Med 346:1854–1862PubMedCrossRefGoogle Scholar
  15. 15.
    Lamas GA, Orav EJ, Stambler BS et al, for the Pacemaker Selection in the Elderly Investigators (1998) Quality of life and clinical outcomes in elderly patients treated with ventricular pacing as compared with dual-chamber pacing. N Engl J Med 338:1097–1104PubMedCrossRefGoogle Scholar
  16. 16.
    Toff WD, Camm AJ, Skehan JD (2005) Single-chamber versus dual chamber pacing for high-grade atrioventricular block. N Engl J Med 353:145–155PubMedCrossRefGoogle Scholar
  17. 17.
    Sweeney MO, Hellkamp AS, Ellenbogen KA et al, for the Mode Selection Trial (MOST) Investigators (2003) Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation 107:2932–2937PubMedCrossRefGoogle Scholar
  18. 18.
    Tops LF, Schalij MJ, Holman ER (2006) Right ventricular pacing can induce ventricular dyssynchrony in patients with atrial fibrillation after atrioventricular node ablation. J Am Coll Cardiol 48:1642–1648PubMedCrossRefGoogle Scholar
  19. 19.
    Sweeney M, Ellenbogen K, Casavant D et al; The Marquis MVP Download Investigators (2005) Multicenter, prospective, randomized safety and efficacy study of a new atrial-based managed ventricular pacing mode (MVP) in dual chamber ICDs. J Cardiovasc Electrophysiol 16:811–817PubMedCrossRefGoogle Scholar
  20. 20.
    Pioger G, Leny G, Nitzsche R, Ripart A (2007) AAIsafeR Limits Ventricular Pacing in Unselected Patients. PACE 30:S66–S70PubMedGoogle Scholar
  21. 21.
    Milasinovic G, Sperzel J, Smith TW et al, on behalf of The Worldwide EnPulse Investigators) (2006) Reduction of RV pacing by continuous optimization of the AV interval. Pacing Clin Electrophysiol 29(4):406–412PubMedCrossRefGoogle Scholar
  22. 22.
    Melzer C, Sowelam S, Sheldon TJ et al (2005) Induction of right ventricular pacing in patients with sinus node dysfunction using an enhanced search AV algorithm. Pacing Clin Electrophysiol 28:521–527PubMedCrossRefGoogle Scholar
  23. 23.
    Olshansky B, Day J, McGuire M, Pratt T (2005) Inhibition of unnecessary RV pacing with AV search hysteresis in ICDs (INTRINSIC RV): design and clinical protocol. Pacing Clin Electrophysiol 28:62–66PubMedCrossRefGoogle Scholar
  24. 24.
    Mayumi H, Kohno H, Yasui H et al (1996) Use of automatic mode change between DDD and AAI to facilitate native atrioventricular conduction in patients with sick sinus syndrome or transient atrioventricular block. Pacing Clin Electrophysiol 19:1740–1747PubMedCrossRefGoogle Scholar
  25. 25.
    Iliev I, Yamachika S, Muta K et al (2000) Preserving normal ventricular activation versus atrioventricular delay optimization during pacing: the role of intrinsic atrioventricular conduction and pacing rate. Pacing Clin Electrophysiol 23:74–83PubMedCrossRefGoogle Scholar
  26. 26.
    Inoue N, Ishikawa T, Sumita S et al (2006) Suppression of atrial fibrillation by atrial pacing. Circulation J 70:1398–1401CrossRefGoogle Scholar
  27. 27.
    Levy T, Walker S, Rex S, Paul V (2000) Does atrial overdrive pacing prevent paroxysmal atrial fibrillation in paced patients? Int J Cardiol 75:91–97PubMedCrossRefGoogle Scholar
  28. 28.
    Friedman P, Dijkman B, Warman E et al, for the Worldwide Jewel AF Investigators (2001) Atrial therapies reduce atrial arrhythmia burden in defibrillator patients. Circulation 104:1023–1028PubMedCrossRefGoogle Scholar
  29. 29.
    Terranova P, Valli P, Terranova P et al (2006) Pacemaker Prevention therapy in drug-refractory paroxysmal atrial fibrillation: reliability of diagnostics and effectiveness of prevention pacing therapy in Vitatron™ Selection® Device. Indian Pacing Electrophysiol J 6(2):63–74PubMedGoogle Scholar
  30. 30.
    Puglisi A, Altamura G, Capestro F et al (2003) Impact of closed-loop stimulation, overdrive pacing, DDDR pacing mode on atrial tachyarrhythmia burden in bradytachy syndrome. A randomized study. Eur Heart J 24:1952–1961PubMedCrossRefGoogle Scholar
  31. 31.
    De Simona A, Senatore G, Donnici G et al (2007) Dynamic and dual-site atrial pacing in the prevention of atrial fibrillation: The STimolazione Atriale Dinamica Multisito (STADIM) Study. PACE 30:S71–S74Google Scholar
  32. 32.
    Gillis A, Unterberg-Buchwald C, Schmidinger H et al, for the GEM III AT Worldwide Investigators (2002) Safety and efficacy of advanced atrial pacing therapies for atrial tachyarrhythmias in patients with a new implantable dual chamber cardioverter-defibrillator. J Am Coll Cardiol 40:1653–1659PubMedCrossRefGoogle Scholar
  33. 33.
    Purerfellner H, Doza P, Ruiter P et al, for the PMOP Investigators (2006) Reduction of atrial tachyarrhythmia episodes during the overdrive pacing period using the post-mode switch overdrive pacing (PMOP) algorithm. Heart Rhythm 3:1164–1171PubMedCrossRefGoogle Scholar
  34. 34.
    Israel C, Hu B, Unterberg C et al, on behalf of the AT500 Verification Study Investigators (2001) Pace-termination and pacing for prevention of atrial tachyarrhythmias: results from a multicenter study with an implantable device for atrial therapy. J Cardiovasc Electrophysiol 12:1121–1128PubMedCrossRefGoogle Scholar
  35. 35.
    Carlson M, Ip J, Messenger J et al, for the ADOPT Investigators (2003) A new pacemaker algorithm for the treatment of atrial fibrillation. Results of the Atrial Dynamic Overdrive Pacing Trial (ADOPT). J Am Coll Cardiol 42:627–633PubMedCrossRefGoogle Scholar
  36. 36.
    Lee M, Weachter R, Pollak S et al, for the ATTEST Investigators (2003) The effect of atrial pacing therapies on atrial tachyarrhythmia burden and frequency results of a randomized trial in patients with bradycardia and atrial tachyarrhythmias. J Am Coll Cardiol 41:1926–1932PubMedCrossRefGoogle Scholar
  37. 37.
    Friedman P, Dijkman B, Warman E et al (2001) Atrial therapies reduce atrial arrhythmia burden in defibrillator patients. Circulation 104:1023–1028PubMedCrossRefGoogle Scholar
  38. 38.
    Gold MR, Hoffmann E, for the SAFARI Investigators (2006) Rationale and design of a randomized clinical trial to assess the role of overdrive and triggered prevention pacing therapies in reducing atrial fibrillation: the Study of Atrial Fibrillation Reduction (SAFARI). Am Heart J 152:231–236PubMedCrossRefGoogle Scholar
  39. 39.
    Misier AR, Opthof T, van Hemel NM (1992) Increased dispersion of refractoriness in patients with idiopathic atrial fibrillation. J Am Coll Cardiol 19:1531–1535PubMedCrossRefGoogle Scholar
  40. 40.
    D’Allonnes GR, Pavin D, Leclercq C et al (2000) Long term effects of biatrial synchronous pacing to prevent drug-refractory atrial tachyarrhythmia: a 9-year experience. J Cardiovasc Electrophysiol 11:1081–1091PubMedCrossRefGoogle Scholar
  41. 41.
    Daubert C, Leclercq C, Le Breton H et al (1997) Permanent left atrial pacing with a specifically designed coronary sinus lead. Pacing Clin Electrophysiol 20:2755–2764PubMedCrossRefGoogle Scholar
  42. 42.
    Saksena S, Prakash A, Hill M et al (1996) Prevention of recurrent atrial fibrillation with chronic dual-site right atrial pacing. J Am Coll Cardiol 28:687–694PubMedCrossRefGoogle Scholar
  43. 43.
    Delfault P, Saksena S, Prakash A et al (1998) Long-term outcome of patients with drug-refractory atrial flutter and fibrillation after single-and dual-site right atrial pacing for arrhythmia prevention. J Am Coll Cardiol 32:1900–1908CrossRefGoogle Scholar
  44. 44.
    Saksena S, Prakash A, Ziegler P et al, for the DAPPAF Investigators (2002) Improved suppression of recurrent atrial fibrillation with dual-site right atrial pacing and antiarrhythmic drug therapy. J Am Coll Cardiol 40:1140–1150PubMedCrossRefGoogle Scholar
  45. 45.
    Leclercq JF, De Sisti A, Fiorello P et al (2000) Is dual site better than single site atrial pacing in the prevention of atrial fibrillation? Pacing Clin Electrophysiol 23:2101–2107PubMedCrossRefGoogle Scholar
  46. 46.
    Lau CP, Tse HF, Yu CM et al (2001) Dual-site atrial pacing for atrial fibrillation in patients without bradycardia. Am J Cardiol 88:371–375PubMedCrossRefGoogle Scholar
  47. 47.
    Mirza I, James S, Holt P (2002) Biatrial pacing for paroxysmal atrial fibrillation. A randomized prospective study into the suppression of paroxysmal atrial fibrillation using biatrial pacing. J Am Coll Cardiol 40:457–463PubMedCrossRefGoogle Scholar
  48. 48.
    Levy T, Walker S, Rex S et al (2001) No incremental benefit of multi-site atrial pacing compared with right atrial pacing in patients with drug refractory paroxysmal atrial fibrillation. Heart 85:48–52PubMedCrossRefGoogle Scholar
  49. 49.
    Crystal E, Connolly SJ, Sleik K et al (2002) Interventions on prevention of postoperative atrial fibrillation in patients undergoing heart surgery. A meta-analysis. Circulation 106:75–80PubMedCrossRefGoogle Scholar
  50. 50.
    Olshansky B, Rosenfeld L, Warner A et al; the AFFIRM Investigators (2004) The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. Approaches to control rate in atrial fibrillation. J Am Coll Cardiol 43:1201–1208PubMedCrossRefGoogle Scholar
  51. 51.
    Wood M, Brown-Mahoney C, Kay G, Ellenbogen K (2000) Clinical outcomes after ablation and pacing therapy for atrial fibrillation — a meta-analysis. Circulation 101:1138–1144PubMedGoogle Scholar
  52. 52.
    Tops L, Schalij M, Holman E et al (2006) Right ventricular pacing can induce ventricular dyssynchrony in patients with atrial fibrillation after atrioventricular node ablation. J Am Coll Cardiol 48:1642–1648PubMedCrossRefGoogle Scholar
  53. 53.
    Leon A, Greenberg J, Kanuru N et al (2002) Cardiac resynchronization in patients with congestive heart failure and chronic atrial fibrillation. Effect of biventricular pacing after chronic right ventricular pacing. J Am Coll Cardiol 39:1258–1263PubMedCrossRefGoogle Scholar
  54. 54.
    Doshi R, Daoud E, Fellows C et al for the PAVE Study Group (2005) Left ventricular-based cardiac stimulation post av nodal ablation evaluation (The PAVE Study). J Cardiovasc Electrophysiol 16:1160–1165PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2007

Authors and Affiliations

  • Oscar Oseroff
    • 1
  • Gustavo Iralde
    • 1
  • Enrique Retyk
    • 1
  1. 1.Pacing and Electrophysiology DivisionBazterrica ClinicBuenos AiresArgentina

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