Dual-site right atrial pacing is safe, achieves long-term rhythm control in most patients, decreases the need for cardioversion, and antithrombotic therapy can be selectively reduced. High right atrial and coronary sinus ostial pacing do not differ in efficacy. Prevention of AF is enhanced by dual-site right atrial pacing. refractory periods, causing susceptibility to atrial fibrillation and VF. Atrial pacing in combination with antiarrhythmic drugs eliminates or markedly reduces recurrent AF. As a result, the repolarization period is extended and there is an increase in. Coronary sinus ostial lead dislodgement was not observed after discharge.Ĭonclusions. Ectopic atrial tachycardia (EAT), or automatic atrial tachycardia, is an arrhythmia arising from both atria with inappropriately fast atrial rates.This tachycardia represents approximately 10 of the SVT seen in the overall population. The need for cardioversion was reduced after pacemaker implant (p < 0.05) and antithrombotic therapy was reduced (p < 0.06) without any thromboembolic event. Rhodes, in Electrophysiological Disorders of the Heart (Second Edition), 2012 Ectopic Atrial Tachycardia. Seventy-eight percent of patients at 1 year and 56% at 3 years remained free of symptomatic AF. Effective rhythm control was achieved in 86% of patients during dual right atrial pacing. High right atrial pacing and coronary sinus ostial pacing had similar efficacy for AF prevention. Dual-site right atrial pacing significantly increased the proportion of patients free of AF recurrence (89%) as compared to single-site right atrial pacing (62%, p = 0.02). Mean arrhythmia-free intervals increased from 9 ± 10 days in the control period preceding implant to 143 ± 110 days (p < 0.0001) in single-site right atrial pacing and 195 ± 96 days in dual-site right atrial pacing (p < 0.005 versus single-site pacing and p < 0.0001 versus control). Single-site atrial pacing was performed at the high right atrium or the coronary sinus ostium. Thirty consecutive patients with drug-refractory symptomatic AF and documented primary or drug-induced bradycardia were implanted with a dual chamber rate-responsive pacemaker and two atrial leads. Also examined was the efficacy of two single-site right atrial pacing modes (high right atrium and coronary sinus ostium) and the long-term need for cardioversion, antithrombotic and antiarrhythmic drug therapies during dual-site atrial pacing. An initial crossover study comparing dual- and single-site right atrial pacing was performed followed by a long-term efficacy and safety evaluation of dual-site right atrial pacing in patients with drug-refractory atrial fibrillation (AF). 5.4 Atrial flutter 5.10 Implantable cardioverter defibrillators. Treatment failures tend to occur early in the course of follow-up, permitting easy identification of candidates for alternative therapeutic approaches.Objectives. An implantation of a single-chamber implantable cardioverter defibrillator (ICD) was indicated. Thus, despite previous unsuccessful drug trials, a substantial proportion of patients with recurrent symptomatic atrial fibrillation refractory to conventional therapy can be treated successfully and safely with newer antiarrhythmic drugs. The incidence of intolerable side effects necessitating discontinuation of therapy ranged from 7% to 8% The cumulative proportion of patients successfully treated with propafenone or sotalol, or both, by 6 months was 55% and remained relatively constant beyond that point. The percent of patients free of recurrent symptomatic arrhythmia at 6 months was 39% for propafenone and 50% for sotalol. Life table estimates of the duration of freedom from atrial fibrillation were constructed for each drug trial. Paroxysmal atrial fibrillation occurred in 56 patients (51 %) and chronic atrial fibrillation occurred in 53 patients (49%).Īfter loading and dose titration phases were completed, the maintenance doses of drugs were 450 to 900 mg/day for propafenone and 160 to 960 mg/day for sotalol. The clinical profile of the study group was as follows: age 63 ± 13 years, left atrial anteroposterior dimension 4.4 ± 0.9 cm and left ventricular ejection fraction 57 ± 14%. One hundred nine patients with recurrent episodes of symptomatic atrial fibrillation or flutter, or both, who had failed one to five previous antiarrhythmic drug trials were treated with propafenone and, subsequently, sotalol if atrial fibrillation recurred.
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