Clinical use of permanent pacemaker for conversion of intraatrial reentry tachycardia in children

The use of the implanted atrial-based pacemaker to overdrive postsurgical i ntraatrial reentry tachycardia (IART) was evaluated in a large group of ped iatric patients over a 14-year study period. The authors sought to determin e the feasibility of this noninvasive technique in the management of this s pecialized population and to determine factors associated with successful c onversion. They examined 128 manual overdrive attempts performed on 22 cons ecutive patients. There were 20 patients with post-Fontan repair, 7 with po st-Mustard/Senning procedure, and 5 with miscellaneous lesion types. The nu mber of IART episodes for overdrive pacing per patient ranged from 1 to 15. The first overdrive pacing attempt was successful in 63% (14/22) of the pa tients. The mean IART cycle length was 278 +/- 59 ms. The mean pacing rate for effective conversion of LART was 66 +/- 10% faster than the IART rate. By controlling for repeated measures for individual patients, three factors were found to be independently associated with a successful outcome: (2) l esion type other than Fontan surgery (P = 0.007), (2) lack of acceleration of IART with the overdrive attempt (P < 0.001), and 131 patient use of amio darone with attempt (P = 0.005). There were three procedural complications: two inadvertent overdrive pacing episodes, and one episode of acceleration of LART cycle length and conduction resulting in need for cardioversion. M anual pacemaker overdrive conversion of IART is a useful adjunct in the man agement of postsurgical IART in the pediatric population and should be cons idered as an initial treatment option.