How do atrial pacing algorithms prevent atrial arrhythmias?

Abstract

With an ageing population, atrial fibrillation has become an increasing cause of hospital admission and morbidity. Pacemaker implantation may prevent atrial tachyarrhythmias by preventing bradycardia and pauses. Implantable devices are now available with specific atrial pacing algorithms designed to prevent atrial arrhythmias. These algorithms work by increasing the atrial pacing rate to achieve continuous overdrive pacing or by responding to triggers such as premature atrial complexes. This article examines how the algorithms work by describing the functions of one of the new generation of pacemakers in detail. Early studies have indicated that the use of preventative pacing can reduce atrial arrhythmia burden and symptomatic atrial fibrillation in selected patients. There are clearly some patients who benefit from implantation of these devices but what remains unclear is how to identify this patient group.

Efficacy of Low Interatrial Septum and Right Atrial Appendage Pacing for Prevention of Permanent Atrial Fibrillation in Patients With Sinus Node Disease

“…[11][12][13][14][15][16][17][18] The use of the data stored by the implanted devices has considerably improved our knowledge of AF, as it does not depend on unreliable subjective reports of symptoms. [11][12][13][14][15][16][17][18] One of the secondary end points of the EPASS study was the time to the first recurrence of any AF lasting more than 5 minutes, thus including paroxysmal AF episodes, as documented by the device diagnostics. No difference in this parameter was noted among groups and subgroups, which is in complete agreement with previous findings by Hermida.…”

“…Both these pacemakers have the CE mark of approval and are equipped with diagnostic and therapeutic algorithms for AF. 12,13 Device setting was aimed to continuously pace the atrium and to minimize ventricular pacing. Device programming was as follows: …”

The effect of atrial pacing on left ventricular diastolic function and BNP levels in patients with DDD pacemaker

“…Atriyal pacing, paroksizmal atriyal fibrilasyonu tetikleyen, rölatif bradikardiyi önleyerek, refrakterlik dispersiyonunu azaltarak, reentri'yi başlatan atriyal, erken vuruları azaltarak atriyal fibrilasyonun başlamasına karşı koruyucu etkide bulunur (12). Yapılan çalışmalar paroksizmal atriyal fibrilasyon ataklarının çoğunda aritmi başlangıcına bradikardinin veya atriyal erken vuruların öncülük ettiğini göstermektedir (13). Yeni nesil iki odacıklı pacemakerlar şimdi atriyal taşiaritmilerin başla-masını önleyen özgül algoritmalara sahiptir.…”

Prevalence of conduction delay of the right atrium in patients with SSS: implications for pacing site selection

“…The data can be retrieved during the programmed follow-up visits. The prevention algorithms used were: Pace Conditioning, to automatically and continuously pace the atrium; post-PAC Response, to suppress the pause after a premature atrial contraction; and PAC-Suppression to prevent the onset of new premature atrial contractions in the 4 min following the detection of the first one [14]. All pacemakers were programmed at a basic rate of 60 beats/min.…”