Atrial Pacing Algorithms for the Prevention of Atrial Fibrillation

  • E. Crystal
  • I. E. Ovsyshcher


Atrial fibrillation (AF) is by far the most common form of sustained cardiac arrhythmia. Primary and secondary prevention of AF is an important clinical goal. The idea of preventing recurrence of AF by different location of the lead(s) and different modes and/or algorithms of pacing has been under evaluation for the last decade. The ability of pacing mode to affect the occurrence of AF was first noted from observational studies [1,2]. During the past several years it was confirmed in four randomized pacing trials [3]. Recent large trials of rhythm control versus rate control in AF - such as the Pharmacological Intervention in Atrial Fibrillation (PIAF) [4], AF Follow-up Investigation in Rhythm Management (AFFIRM)[5], and Rate Control vs Electrical Cardioversion for Persistent Atrial Fibrillation (RACE) trials [6] - suggest that suppression of AF has no effect on the traditional hard outcomes like stroke and cardiovascular death. Reduced frequency and duration of AF, however, is still an important clinical goal in patients with symptomatic AF. The aim of this paper is to review the accumulated data on the pacing algorithms for secondary prevention of AF.


Atrial Fibrillation Atrial Arrhythmia Atrial Pace Atrial Tachyarrhythmia Atrial Fibrillation Episode 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Connolly SJ, Kerr C, Gent M et al (1996) Dual-chamber versus ventricular pacing. Critical appraisal of current data. Circulation 94:578–583PubMedCrossRefGoogle Scholar
  2. 2.
    Ovsyshcher IE, Hayes DL, Furman S (1998) Dual-chamber pacing is superior to ventricular pacing: fact or controversy? Circulation 97:2368–2370PubMedCrossRefGoogle Scholar
  3. 3.
    Cooper JM, Katcher MS, Orlov MV (2002) Implantable devices for the treatment of atrial fibrillation. N Engl J Med 346:2062–2068PubMedCrossRefGoogle Scholar
  4. 4.
    Hohnloser SH, Kuck KH (2001) Randomized trial of rhythm or rate control in atrial fibrillation: the Pharmacological Intervention in Atrial Fibrillation Trial (PIAF). Eur Heart J 22:801–802PubMedCrossRefGoogle Scholar
  5. 5.
    Wyse DG (2002) Atrial Fibrillation Follow-up Investigation in Rhythm Management. Annual Scientific Sessions of the American College of CardiologyGoogle Scholar
  6. 6.
    Crijns HJ (2002) Rate Control vs Electrical Cardioversion. Annual Scientific Sessions of the American College of CardiologyGoogle Scholar
  7. 7.
    Garrigue S, Barold SS, Cazeau S et al (1998) Prevention of atrial arrhythmias during DDD pacing by atrial overdrive. Pacing Clin Electrophysiol 21:1751–1759PubMedCrossRefGoogle Scholar
  8. 8.
    Levy T, Walker S, Rex S et al (2000) Does atrial overdrive pacing prevent paroxysmal atrial fibrillation in paced patients? Int J Cardiol 75:91–97PubMedCrossRefGoogle Scholar
  9. 9.
    Levy T, Walker S, Rochelle J et al (1999) Evaluation of biatrial pacing, right atrial pacing, and no pacing in patients with drug refractory atrial fibrillation. Am J Cardiol 84: 426–429PubMedCrossRefGoogle Scholar
  10. 10.
    Ward KJ, Willett JE, Bucknall C et al (2001) Atrial arrhythmia suppression by atrial overdrive pacing: pacemaker Holter assessment. Europace 3:108–114PubMedCrossRefGoogle Scholar
  11. 11.
    Funck RC, Adamec R, Lurje L et al (2000) Atrial overdriving is beneficial in patients with atrial arrhythmias: first results of the PROVE Study. Pacing Clin Electrophysiol 23:1891–1893PubMedGoogle Scholar
  12. 12.
    Wiberg S, Lonnerholm S, Jensen S et al (2001) Effect of right atrial overdrive pacing on symptomatic attacks of atrial fibrillation: a multicenter randomized study. Pacing Clin Electrophysiol 24:A554Google Scholar
  13. 13.
    Lam CT, Lau CP, Leung SK et al (2000) Efficacy and tolerability of continuous overdrive atrial pacing in atrial fibrillation. Europace 2:286–291PubMedCrossRefGoogle Scholar
  14. 14.
    Remmen JJ, Verheugt FW (2001) The hotline sessions of the 23rd European congress of cardiology. Eur Heart J 22:2033–2037PubMedCrossRefGoogle Scholar
  15. 15.
    Camm AJ (2002) AFtherapy study: preventive pacing for paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 24:Al25Google Scholar
  16. 16.
    Carlson MD, Gold MR, Messenger JC et al (2001) Dynamic atrial overdrive pacing decreases symptomatic atrial arrhythmia burden in patients with sinus node dysfunction. Circulation 104:383Google Scholar
  17. 17.
    Beinhauer A, Vock P, Nobis H et al (2002) Significant reduction of AF burden by the AF supression algorithm DAOTM. Europace 3[Suppl A]:A194Google Scholar
  18. 18.
    Ricci R, Santini M, Puglisi A et al (2001) Impact of consistent atrial pacing algorithm on premature atrial complex number and paroxysmal atrial fibrillation recurrences in brady-tachy syndrome: a randomized prospective crossover study. J Intery Card Electrophysiol 5:33–44CrossRefGoogle Scholar
  19. 19.
    Seidl K, Cazeau S, Gaita F et al (2002) Dual-site pacing vs mono-site pacing in prevention of atrial fibrillation. Pacing Clin Electrophysiol 25(4 pt 1):568 (Abstract)Google Scholar
  20. 20.
    Attuel P, El Allaf D, Konz I et al (2001) Is overdrive pacing useful for the prevention of paroxysmal atrial fibrillation? In: Raviele A (ed) Cardiac arrhythmias Springer, Milan, pp 492–497Google Scholar
  21. 21.
    Murgatroyd FD, Nitzsche R, Slade AK et al (1994) A new pacing algorithm for overdrive suppression of atrial fibrillation. Chorus Multicentre Study Group. Pacing Clin Electrophysiol 17:1966–1973PubMedCrossRefGoogle Scholar
  22. 22.
    Israel CW, Lawo T, Lemke B et al (2000) Atrial pacing in the prevention of paroxysmal atrial fibrillation: first results of a new combined algorithm. Pacing Clin Electrophysiol 23:1888–1890PubMedCrossRefGoogle Scholar
  23. 23.
    de Vusser P, Mairesse GH, Van Mieghem W et al (2001) Significant reduction in atrial fibrillation using circadian overdrive pacing at 80/65 ppm. Pacing Clin Electrophysiol 24:663AGoogle Scholar
  24. 24.
    Garrigue S, Barold SS, Cazeau S et al (2000) Is there a synergic effect of propafenone associated with atrial overdrive pacing for atrial arrhythmia prevention? A randomised crossover study. Heart 83:172–177PubMedCrossRefGoogle Scholar
  25. 25.
    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

Copyright information

© Springer-Verlag Italia 2003

Authors and Affiliations

  • E. Crystal
    • 1
    • 2
  • I. E. Ovsyshcher
    • 1
  1. 1.Department of Cardiology, Soroka University Medical Center, Faculty of Health SciencesBen-Gurion UniversityIsrael
  2. 2.Division of Cardiology, Sunnybrook and Women’s College Health Science Center, Faculty of Health SciencesUniversity of TorontoCanada

Personalised recommendations