Effect of atrial antitachycardia pacing treatments in patients with an atrial defibrillator: randomised study comparing subthreshold and nominal pacing outputs

Role of High Frequency Atrial Pacing for the Termination of Acute Atrial Fibrillation and Atypical Atrial Flutter

“…Antitachycardia pacing has been proven to be effective in the termination of acute atrial tachyarrhythmias 12–16,18,25 . However, the value of HF pacing algorithms in reducing AF burden remains controversial 18–22 .…”

“…The main contribution of this study is to demonstrate that HF pacing is significantly more effective in terminating acute AF as compared to no pacing within a prospective, randomized, controlled trial. Especially the randomized comparison of two pacing sites and the option of two separate sensing locations allowing to differentiate between AF and AAFL is an advantage as compared to trials investigating the diagnostic and therapeutic options of implantable devices with a fixed single lead position 12–16,25,26 …”

“…Recent experimental and clinical studies 4–6 suggest that early termination of AF paroxysms is the most efficient way to prevent further AF activity. Since atrial capture and entrainment during AF may be reproducibly achieved by high‐frequency (HF) atrial stimulation, 7–11 several trials were performed investigating the terminating efficacy of HF pacing therapies in patients with implantable atrial devices 12–17 . These studies demonstrate that up to 54% 14,17 of fast atrial arrhythmias (FAAs) including acute AF, typical atrial flutter, or atypical atrial flutter (AAFL) episodes may be successfully converted by HF pacing algorithms.…”

“…In contrast, the majority of experimental 7–11 and clinical 18,19 trials failed to prove efficacy of pace‐termination of AF. These conflicting results may arise from the fact that most studies with implantable devices do not differentiate between AF and AAFL; however, the latter appears to be affected by HF pacing more successfully 13–15,18,19 . Furthermore, the pacing site may also influence the outcome.…”

Does Sinus Rhythm Beget Sinus Rhythm?

“…Similarly, the use of anti-AF pacing algorithms has not been well studied in persistent AF patients. 20,21 Suppression of only a few episodes may markedly increase the duration between episodes and correspondingly decrease the requirement for atrial defibrillation. This reduction in atrial defibrillation requirement and frequency, may have beneficial effects on patient quality of life.…”