Implanted atrial pacemakers for paroxysmal atrial flutter. Long-term efficacy.

Five patients with drug-resistant paroxysmal atrial flutter received permanent burst atrial pacemakers for the treatment of tachycardia. All patients had extensive electrophysiologic evaluations to determine the safety and efficacy of atrial pacing. The absence of prolonged spontaneous or electrically induced atrial fibrillation was also documented in all patients. Three pulse generators were patient activated (nonautomatic) and two were multiprogrammable and automatic. The atrial pacemakers terminated many attacks of paroxysmal atrial flutter safely and reliably in a follow-up period ranging from 24 to 60 months (average, 42). No major complications developed. In four patients, concomitant drug therapy was necessary, although to a lesser degree, to reduce the frequency of attacks and the ventricular rate. Our study documents the long-term efficacy and low risk associated with permanent-burst atrial pacing in the treatment of drug-refractory paroxysmal atrial flutter in selected patients.