Hemels Martin E W, Wiesfeld Ans C P, Inberg Bas, Van Dessel Pascal F H M, Nieuwland Wiebe, Tan Eng S, Mulder Henk, Van Veldhuisen Dirk J, Van Gelder Isabelle C
Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, The Netherlands.
Europace. 2006 Feb;8(2):107-12. doi: 10.1093/europace/euj004. Epub 2006 Jan 5.
Our aim was to investigate whether right atrial overdrive pacing is effective for the prevention of atrial fibrillation (AF) in patients without bradyarrhythmias.
Patients with symptomatic paroxysmal or persistent AF refractory to at least two Class I or III antiarrhythmic drugs and without bradyarrhythmias were included. Successful therapy was defined as the combination of (a) a reduction of AF burden with or without AAD use >75%, (b) total AF burden < or =5% per year, and (c) less than one electrical cardioversion per year. Lower rate was set at 70 b.p.m. Additional AF prevention and termination features were used in case of no success. After a median follow-up of 18 (10-55) months, therapy was effective in 19 of the 36 included patients (53%). In 74% of the successfully treated patients, additional antiarrhythmic drugs were used. In successfully treated patients, the AF burden was reduced from 15% (5-100%) to 0% (0-4%). Multivariate analysis showed that the concomitant use of a Class I or III antiarrhythmic drug, a lower AF burden before implantation and the use of an angiotensin converting enzyme inhibitor were predictors of successful therapy.
Right atrial overdrive pacing in combination with antiarrhythmic drugs seems an attractive treatment option in drug refractory symptomatic AF patients.
我们的目的是研究右心房超速起搏对无缓慢性心律失常患者预防心房颤动（AF）是否有效。
纳入至少对两种I类或III类抗心律失常药物治疗无效且无缓慢性心律失常的有症状阵发性或持续性AF患者。成功治疗定义为以下情况的组合：（a）无论是否使用抗心律失常药物（AAD），房颤负荷降低>75%；（b）每年总房颤负荷<或 =5%；（c）每年电复律少于一次。较低心率设定为70次/分钟。若未成功，则使用额外的房颤预防和终止功能。中位随访18（10 - 55）个月后，36例纳入患者中有19例（53%）治疗有效。在74%成功治疗的患者中，使用了额外的抗心律失常药物。成功治疗的患者中，房颤负荷从15%（5 - 100%）降至0%（0 - 4%）。多变量分析显示，同时使用I类或III类抗心律失常药物、植入前较低的房颤负荷以及使用血管紧张素转换酶抑制剂是成功治疗的预测因素。
右心房超速起搏联合抗心律失常药物似乎是药物难治性有症状房颤患者的一种有吸引力的治疗选择。
