CLINICAL OBSERVATIONS WITH LONG-TERM ATRIAL-PACING

Atrial pacing (AP), despite its beneficial hemodynamic and antiarrhyth mic effect, is still an underused mode of stimulation. The main purpos e of this stud, was to evaluate the long-term results of AP. Sixty fou r patients (pts) with sinus node disease (28 male and 36 female: mean age 54,2; range:44-88 years), 3,2% of the total implantation at our cl inic were treated with AP between 1982-96. Criteria for atrial pacing were: no AV block in the history, no Ay-block during carotid sinus mas sage, Wenckebach point>130/min, left atriium<50mm, left ventricular EF >40%. The indication for pacing was predominant sinus bradycardia (SE) in 34 pts and tachycardia-bradycardia syndrome (TT;SS) in 30 pts. Pts with TBS were on antiarrhythmic treatment, while most pts with SE rec eived no antiarrhythmic drugs. All the pfs were checked up at every 3- 6 month. Sixty-two pts were followed for 3-154 (mean: 67) months, two pts were lost for follow-up. Repeated lead dislodgment occurred in two pts, which made a pacing mode change necessary. Four pts died during the follow-up period for non-cardiac reasons. At the end of the follow -up period the data of 60 pts were available for evaluation (33 pts wi th SE, 27 pts with (TBS). All the pts with SE were in sinus rhythm, an d no patient developed AV block by the end of the follow-up period Sev en out of 27 pts with TBS developed chronic atrial fibrillation, 3 out of them suffered a cerebral embolism; the remaining 20 pts were in si nus rhythm, and the number of paroxysmal attacks decreased significant ly, which improved their quality of life significantly. Three pts in t his group developed a temporary complete AV block, which regressed wit h decreasing the dosage of antiarrhythmic drugs. Atrial pacing is prov ed to be a safe and reliable treatment for sick sinus syndrome. Proper patient selection is crucial in preventing the development of AV cond uction disturbance. Atrial stimulation had a satisfactory long-term an tiarrhythmic effect in pts with sick sinus syndrome (SSS).