BLIND ATRIAL-PACING FOR PATIENTS WITH SINUS NODE DISEASE WHO DEVELOP ATRIAL-FIBRILLATION DURING PERMANENT PACEMAKER IMPLANTATION

During a 6-year period, six of 110 patients implanted with AAI pacemak ers for sick sinus syndrome developed atrial fibrillation at the time of pacemaker implantation (5.5%). In all cases a passive fixation lead was sited in the right atrial appendage, its stability being ensured by rotation of the lead and phrenic nerve stimulation excluded by paci ng at 10 V. One patient remained in chronic atrial fibrillation. In th e other live, who subsequently reverted to sinus rhythm, atrial P-wave sensing and lead threshold values were satisfactory, allowing program ming of the pacemaker output down to 2.5 V to conserve the battery. On e out of these five patients continued to have intermittent atrial fib rillation, We conclude that in sick sinus syndrome, atrial fibrillatio n complicates AAI pacemaker implantation procedure in 5.5% of cases. A s an alternative to appendage in thue expectation of a spontaneous rev ersion to sinus rhythm with a good lead threshold and P-wave sensing. In contrast to inappropriate pacing of the right ventricle in VVI mode , this strategy avoids pacemaker syndrome and reduces the risk of subs equent attacks of atrial fibrillation. Copyright (C) 1997 Elsevier Sci ence Ireland Ltd.