Atrial arrhythmia suppression by atrial overdrive pacing: pacemaker Holterassessment

The purpose of this study was to assess the efficacy of overdrive, single-s ite right atrial appendage pacing to reduce the burden of atrial fibrillati on (AF) when compared with a standard lower rate limit of 60 bpm. This was verified by using the pacemaker's Holter. Eighteen subjects with a pre-implant history of paroxysmal AF and implanted DDDR mode-switching pacemakers were recruited. The pacemaker lower rate li mit was programmed in random order to 60, 75 or 90 bpm for three 2-month pe riods and the amount of AF quantified. In addition, the exercise tolerance (ET), general well being (GWB), functional capacity (FC) and specific sympt om prevalence (SSP) were assessed. The main finding of the study was that when ranked according to the amount of AF, there Was no significant difference in the amount of AF according to the pacing rate. Six patients failed to tolerate pacing at 90 bpm. There w ere no differences in the ET, GWB, FC and SSP scores. It is concluded that those clinicians that manage patients with paroxysmal AF and desire arrhythmia suppression should now consider alternative pacing strategies. (Europace 2001; 3:103-114) (C) 2001 The European Society of Ca rdiology.