Contributions of permanent cardiac pacing in the treatment of atrial fibrillation.

Newer indications for permanent cardiac stimulation include the prevention of paroxysmal atrial fibrillation (AF) and cardiac resynchronisation in patients suffering from advanced heart failure. Direct comparisons between VVI and DDD or AAI pacing showed an advantage conferred by physiological pacing on the risk of developing AF during long-term follow-up in patients with sinus node dysfunction, AV block, or both. Furthermore, in patients with conventional pacing indications and paroxysmal atrial tachyarrhythmias, a high percentage of atrial pacing was associated with a lighter AF burden. This article reviews several important issues involved in the optimisation of cardiac pacing with a view to prevent paroxysmal AF by new, dedicated pacing algorithms. The AF Suppression trade mark algorithm significantly reduced the rates of symptomatic paroxysmal AF. This algorithm, which confers its benefit by maintaining the atrial pacing rate slightly above the spontaneous sinus rate, should be activated in patients with a history of atrial tachyarrhythmia. Implanting the lead in the low atrial septum seems to reduce further the frequency of tachyarrhythmic events. Future indications for this mode of pacing may be extended to patients at high risk of new-onset or recurrent AF, such as candidates for cardiac resynchronisation therapy or implantable cardioverter/defibrillator recipients.