Atrial Pacing for Prevention of Atrial Fibrillation: Where and How to Stimulate?
Nonpharmacologic therapies are now being increasingly used in patients with recurrent and refractory atrial fibrillation (AF). These include direct atrial surgery, catheter-based atrial ablation, internal atrial defibrillation and atrial pacing. In retrospective and prospective studies, atrial pacing has reduced the frequency and incidence of AF in patients with sick sinus syndrome without and with manifest AF [1–3]. Similar observations have been made in populations with bradycardia or vagally mediated AF . More sophisticated pacing algorithms and methods such as continuous atrial pacing and dual-site atrial pacing have been suggested to enhance efficacy of atrial pacing [5, 6]. The application of appropriate atrial pacing methods in specific populations with AF or at risk for AF is examined in this commentary. To comprehend the basis for future recommendations, it is valuable to consider the electrophysiologic basis for antiarrhythmic effects of atrial pacing and the clinical data presently available for making current recommendations.
KeywordsAtrial Fibrillation Atrial Flutter Atrial Pace Rhythm Control Sick Sinus Syndrome
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