Dual-site atrial pacing for atrial fibrillation in patients without bradycardia

Atrial pacing has been shown to delay the onset of atrial fibrillation (AF) when compared with ventricular pacing in patients with sick sinus syndrome . The role for pacing in the control of AF in patients without bradycardia is uncertain. We performed a randomized, crossover, single-blinded study in 22 patients (14 women, aged 63 +/- 10 years) with paroxysmal AF refractory to treatment with oral sotalol (202 +/- 68 mg/day) and no bradycardic indi cation for pacing. All patients received a dual-chamber pacemaker with 2 at rial pacing leads positioned at the high right atrium and coronary sinus os tium, respectively. Patients were randomized in a crossover fashion to be p aced for 12 weeks, either with high right atrial (RA) pacing at 30 beats/mi n ("Off") or dual-site RA pacing with an overdrive algorithm that maintaine d atrial pacing at a rate slightly above the sinus rate ("On"). Treatment o n resulted in a significantly higher percentage of atrial pacing and a redu ction in atrial ectopic frequency than the treatment off period. The time t o the first clinical AF recurrence was prolonged (15 +/- 17 to 50 +/- 35 da ys, p = 0.006), and total AF burden was reduced (45 +/- 34% vs 22 +/- 29%, p = 0.04) in the on-treatment phase. However, there was no difference in AF checklist symptom scores or overall quality-of-life measures. Dual-site RA pacing with continued sinus overdrive prolonged the time to AF recurrence and decreased AF burden in patients with paroxysmal AF. The absence of a ma jor impact on symptom control suggests that pacing should be used as an adj unctive therapy with other treatment modalities for AF. (C) 2001 by Excerpt a Medica, Inc.