[Role of permanent pacing in the prevention and treatment of atrial fibrillation].

Atrial fibrillation onset is enhanced by the presence of sinus bradycardia and sinus pauses. Cardiac pacing, by avoiding them, may prevent tachyarrhythmias. The atrial-based modes of pacing (AAI or DDD) demonstrated to be superior to ventricular pacing mode (VVI) in terms of reduction of atrial fibrillation burden and thromboembolic consequences of the arrhythmia. Many pacing algorithms have been proposed to ensure the maximum percentage of atrial pacing and to avoid post-extrasystolic pauses, both conditions that are needed to reduce atrial fibrillation burden. Moreover, it has been demonstrated that the efficacy in preventing the arrhythmia is superior if the site of pacing is a critical site for interatrial conduction, like Bachmann bundle or the low interatrial septum at the level of Koch triangle. Finally, also early treatment of the arrhythmia by overdrive or high-frequency pacing may contribute to reduce recurrences. Guidelines that have been published in the last years confirm that atrial-based pacing is effective in preventing atrial fibrillation in sick sinus syndrome, whereas the usefulness of prevention algorithms, alternative sites of pacing and pacing therapies is still under debate and further studies are needed.