TREATMENT OF SUPRAVENTRICULAR ARRHYTHMIAS BY PERMANENT PACING

Most pacemakers are used for the treatment of bradyarrhythmias. Howeve r, a small number of pacemakers has been implanted for the treatment o f supraventricular tachycardia resistant to medical therapy. The resul ts of small reported series show long-term pacing to be effective in t erminating reentrant atrial and junctional tachycardia. This has led t o an improved quality of life and fewer hospital admissions in the maj ority of patients. Although there are a number of limitations to the w idespread use of this mode of treatment, the development of pacing tec hniques has improved our understanding of the mechanism of termination of tachycardia which has been fully used in ventricular tachyarrhythm ias. In addition to the curative treatment of sustained junctional tac hycardia, pacemakers have been implanted to prevent the occurrence of new episodes with seemingly equally satisfactory results. However, car diac pacing for this indication is much less common now because of the very good results obtained recently by radiofrequency ablation techni ques. The prevention of atrial arrhythmias, vagally-induced atrial tac hyarrhythmias and the bradycardia-tachycardia syndrome are good indica tions for permanent pacing. The prevention of atrial fibrillation in s inus node dysfunction by pacing is becoming more popular with the emer gence of new modes (DDI and rate-adjusted modes) and original arrhythm ia preventing algorithms. The discussion about the real efficacy of at rial pacing in sinus node dysfunction is disappearing as results of pr ospective randomised trials confirming this efficacy become available, especially in preventing atrial fibrillation.