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Pacing, ICD, or Both for the Hybrid Therapy of Atrial Arrhythmias?

  • G. Boriani
  • M. Biffi
  • C. Martignani
  • C. Camanini
  • C. Valzania
  • I. Corazza
  • G. Calcagnini
  • P. Bartolini
  • A. Branzi
Conference paper

Abstract

Atrial fibrillation (AF) is the most common cardiac arrhythmia, and its prevalence is expected to increase further in the coming years W. The treatment of recurrent paroxysmal AF is frustrating in clinical practice, due to the high rate of recurrences and the lack of uniformly effective treatments [2-4]. Antiarrhythmic drugs are classically the first approach to preventing AF recurrences, but no more than 50% of patients respond to drug therapy within 1 year [2-4]. In view of this limited efficacy and the risk of proarrhythmia, especially in patients with left ventricular dysfunction, new, nonpharmacological treatments for AF are being developed [5,6]. These treatments may be classified as: rescue (catheter-based atrial cardioversion), curative (focal ablation), suppressive (atrial pacing algorithms), and palliative (ablate and pace strategy). No definite algorithms for choosing the most appropriate treatment in the individual patient have been developed. The therapeutic approach for patients with AF remains clinical and is primarily guided by the clinical presentation of the AF. A series of important questions regarding nonpharmacological treatments are still open; they relate to the selection of candidates for any of these treatments or particular combinations of treatments, the true efficacy, the patient acceptance, the risk-benefit and cost-benefit ratios, and the related social costs.

Keywords

Atrial Fibrillation Atrial Pace Sick Sinus Syndrome 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.

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References

  1. 1.
    Kannel WB, Wolf PA, Benjamin EJ, Levy D (1998) Prevalence, incidence, prognosis and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol 82:2N–9NPubMedCrossRefGoogle Scholar
  2. 2.
    Waktare J, Camm A (1998) Acute treatment of atrial fibrillation: why and when to mantain sinus rhythm. Am J Cardiol 81:3C–15CPubMedCrossRefGoogle Scholar
  3. 3.
    Van Gelder I, Crijns HJGM (1998) Cardioversion of atrial fibrillation and subsequent maintenance of sinus rhythm. Pacing Clin Electrophysiol 20:2675–2683CrossRefGoogle Scholar
  4. 4.
    Boriani G, Biffi M, Branzi A, Magnani B (1998) Pharmacological treatment of atrial fibrillation: a review on prevention of recurrences and control of ventricular respon-se. Arch Gerontol Geriatr 27:127–139PubMedCrossRefGoogle Scholar
  5. 5.
    Lesh MD, Kalman JM, Roithinger FX, Karch MR (1997) Potential role of hybrid therapy for atrial fibrillation. Semin Intery Cardiol 2:267–271Google Scholar
  6. 6.
    Krol RB, Saksena S, Prakash A (2000) New devices and hybrid therapies for treatment of atrial fibrillation. J Intery Card Electrophysiol 4:163–169CrossRefGoogle Scholar
  7. 7.
    Feuer J, Shalding A, Messeguer J (1989) Influence of cardiac pacing mode on longterm development of atrial fibrillation. Am J Cardiol 64:1376–1379PubMedCrossRefGoogle Scholar
  8. 8.
    Grimm W, Langfeld H, Maisch B, Kochsiek K (1990) Symptom, cardiovascular profile and spontaneous ECG in paced patients: a five year follow-up study. Pacing Clin Electrophysiol 13:2086–2090PubMedCrossRefGoogle Scholar
  9. 9.
    Hesselson A, Parsonnet V, Bernstein A, Bonavita G (1992) Deleterious effects of longterm single chamber ventricular pacing in patients with sick sinus syndrome: the hidden benefits of dual-chamber pacing. J Am Coll Cardiol 19:1542–1549PubMedCrossRefGoogle Scholar
  10. 10.
    Rosenqvist M, Brandt J, Schuller H (1988) Long-term pacing in sinus node disease: effects of stimulation mode on cardiovascular morbidity and mortality. Am Heart J 116:16–22PubMedCrossRefGoogle Scholar
  11. 11.
    Stangl K, Seitz K, Wirtzfeld A, Alt E, Blomer H (1990) Differences between atrial single chamber pacing (AAI) and ventricular single chamber pacing (VVI) with respect to prognosis and antiarrhythmic effect on patients with sick sinus syndrome. Pacing Clin Electrophysiol 13:2080–2085PubMedCrossRefGoogle Scholar
  12. 12.
    Zanini R, Facchinetti A, Gallo G, Cazzamalli L, Bonandi L, Dei Cas L (1990) Morbidity and mortality of patients with sinus node disease: comparative effects of atrial and ventricular pacing. Pacing Clin Electrophysiol 13:2076–2079PubMedCrossRefGoogle Scholar
  13. 13.
    Sgarbossa E, Pinsky S, Maloney J, Simmons T, Wilkoff B, Castel L, Trohman R (1993) Chronic atrial fibrillation and stroke in paced patients with sick sinus syndrome. Circulation 88:1045–1053PubMedCrossRefGoogle Scholar
  14. 14.
    Andersen H, Thuesen L, Bagger J, Vesterllund T, Thomsen P (1994) Prospective randomised trial of atrial versus ventricular pacing in sick sinus syndrome. Lancet 344:1523–1528PubMedCrossRefGoogle Scholar
  15. 15.
    Cooper JM, Katcher MS, Orlov MV (2002) Implantable devices for the treatment of atrial fibrillation. N Engl J Med 346:2062–2068PubMedCrossRefGoogle Scholar
  16. 16.
    Boriani G, Botto G, Frabetti L, Biffi M, Bellocci F, Bernabb D, Capucci A, Dini P, Leoni G, Lisi F, Marchini A, Morocchini P, Nicotra G, Nipro P, Puglisi A, Ricci R, Spampinato A, Cavaglia S, De Seta F (1998) Does dual chamber pacing prevent paroxysmal atrial fibrillation in brady-tachy patients? G Ital Cardiol 28:121–124Google Scholar
  17. 17.
    Papageorgiou P, Anselme F, Kirchhof C, Monahan K, Rasmussen C, Epstein L, Josephson M (1997) Coronary sinus pacing prevence induction of atrial fibrillation. Circulation 96:1893–1898PubMedCrossRefGoogle Scholar
  18. 18.
    Yu W, Chen S, Tai C, Feng A, Chang M (1997) Effects of different atrial pacing modes on atrial electrophysiology: implicating the mechanism of biatrial pacing in prevention of atrial fibrillation. Circulation 96:2992–2996PubMedCrossRefGoogle Scholar
  19. 19.
    Siedl K, Hamer B, Schwick N (1995) Is the site of atrial lead implantation in dual chamber pacing of importance for preventing atrial fibrillaton? The hidden benefit of lead implantation in the right atrial appendage (abstract). Pacing Clin Electrophysiol 18:1820Google Scholar
  20. 20.
    Padeletti L, Porciani M, Michelucci A, Colella A, Ticci P, Vena S, Costoli A, Ciapetti C, Pieragnoli P, Gensini G (1999) Interatrial septum pacing: a new approach to prevent recurrent atrial fibrillation. J Intery Card Electrophysiol 3:35–43CrossRefGoogle Scholar
  21. 21.
    Delfaut P, Saksena S (2000) Electrophysiological assessment in selecting patients for multisite atrial pacing. J Intery Card Electrophysiol 4:81–85CrossRefGoogle Scholar
  22. 22.
    Levy T, Walker S, Rochelle J, Paul V (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
  23. 23.
    Boriani G, Biffi M, Padeletti A, Spampinato A, Pignalberi C, Botto G, Grammatico A, Piana M, De Seta F, Branzi A (2000) Evaluation of consistent atrial pacing and atrial rate stabilisation algorithms for suppressing recurrent paroxysmal atrial fibrillation in brady-tachy syndrome (abstract). Eur Heart J 21:604CrossRefGoogle Scholar
  24. 24.
    Boriani G, Biffi M, Padeletti L, Spampinato A, Botto G, Pignalberi C, Grammatico A, Piana M, Cavaglià S, De Seta F, Branzi A (1999) Consistent atrial pacing (CAP) and atrial rate stabilisation (ARS): new algorithms to suppress recurrent paroxysmal atrial fibrillation. G Ital Cardiol 29:88–90Google Scholar
  25. 25.
    Carlson MD (2001) The Atrial Dynamic Overdrive Pacing Trial. Presented at the late breaking clinical trials session of the 22nd Annual Scientific Meeting of the North American Society of Pacing and Electrophysiology, Boston, 2–5 May 2001Google Scholar
  26. 26.
    Daubert JC, Mabo P (2002) Implantable devices to treat atrial fibrillation: real prospects or just new gimmicks? Europace 4:161–164PubMedCrossRefGoogle Scholar
  27. 27.
    Boriani G, Biffi M, Martignani C, Luceri R, Bartolini P, Branzi A (2002) Current clinical perspectives on implantable devices for atrial defibrillation. Curr Opin Cardiol 17:82–89PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2003

Authors and Affiliations

  • G. Boriani
    • 1
  • M. Biffi
    • 1
  • C. Martignani
    • 1
  • C. Camanini
    • 1
  • C. Valzania
    • 1
  • I. Corazza
    • 1
  • G. Calcagnini
    • 2
  • P. Bartolini
    • 2
  • A. Branzi
    • 1
  1. 1.Institute of CardiologyUniversity of BolognaItaly
  2. 2.Department of Biomedical EngineeringIstituto Superiore di SanitàRomeItaly

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