The reason for the apparent association between atrial pacing and AF is not clear and may be multifactorial. First, patients needing atrial pacing may have more diseased atria in which AF is more likely to develop, e. Secondly, atrial pacing may itself cause AF by different mechanisms: pacing the right atrium may induce atrial dyssynchrony and subsequent AF. CRT patients. While atrial pacing by some researchers is considered potentially pro-arrhythmogenic, others have focused on atrial overdrive pacing strategies for the prevention of AF.
Results from previous trials with overdrive pacing have not shown a convincing benefit in terms of AF prevention, and these trials included only modest sample sizes. A recent study by Svendsen et al.
For the whole DANPACE trial, the authors did not find an association between AF and stroke, and they speculate that patients with AF due to taking part in a randomized trial were adequately anticoagulated and therefore less likely to develop stroke. Episodes of MS were used as a surrogate marker of AF, and sensitivities and specificities of the used MS algorithms are thus crucial. However, the manufacturer of individual pacemakers was not recorded in DANPACE, and it is thus not possible to discriminate between the various algorithms.
However, it is widely accepted that today's MS algorithms display exhibit a very high degree of sensitivity and specificity for the reliable detection of AF. However, given the efficiency of modern MS algorithms, we consider it unlikely that this would not result in MS episodes which would be detected at the next scheduled follow-up. Although patients with known AF prior to pacemaker implantation were excluded from the study cohort, some patients may have had episodes of undiagnosed AF.
Today, it is not possible to make adjudications of electrogram tracings from the pacemaker memory to exclude significant overdiagnosis of AF. However, we performed the same analyses with MS durations of 6 and 24 h as the criterion for AF leading to similar results. It was, however, impossible to satisfactorily adjust for beta-blocker use because of the heterogeneity of drugs and doses used and their wide variation in patient effects.
It is possible that various atrial lead positions, e. In the present study, we did not have information on the exact position of the atrial lead, yet most leads were implanted in the right atrial appendage or on the lateral wall of the right atrium as is practice in most clinics today.
The present study did not find an association between increasing atrial pacing and development of AF. Whether any causal relationship exists between atrial pacing and AF should be the focus of future randomized trials, exposing patients to different degrees of atrial pacing. Conflict of interest: J. All the other authors declare no conflicts of interest. Google Scholar. Google Preview. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.
Sign In or Create an Account. Sign In. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents Abstract. Does atrial pacing lead to atrial fibrillation in patients with sick sinus syndrome?
Oxford Academic. Sam Riahi. Jens Cosedis Nielsen. Henning R. Select Format Select format. Permissions Icon Permissions. Abstract Aims. Sick sinus syndrome , Sinoatrial node , Pacemakers , Atrial fibrillation , Pacing.
Open in new tab. Figure 1. The need for pacing for either of these indications increases progressively with age. Atrial fibrillation AF is the most common serious arrhythmia. The incidence of AF also increases progressively with age, and patients with pacemakers may be even more prone to AF than comparable patients without pacemakers.
The simplest question to ask is what chamber should be paced to decrease the chance of AF. Most, though not all, retrospective studies indicate that right atrial pacing decreases the incidence of AF compared with pacing in the ventricle.
They demonstrated significant benefit for atrial pacing with improved survival and a decreased incidence of thromboembolic events, AF, and congestive heart failure, especially after longer follow-up. The Mode Selection Trial in Sinus Node Dysfunction MOST , 4 in which all patients had dual chamber rate-responsive DDDR pacemakers implanted but were randomized to ventricular or dual chamber pacing, showed significant but less striking benefits in the incidence of AF and congestive heart failure.
A possible explanation for the difference in the results between the two trials is that unintentional and unnecessary pacing of the right ventricle in the dual chamber group negated some of the benefits of sequential AV pacing compared with ventricular pacing. Two groups have examined the potential benefit of pacing at more than one site in the right atrium with the goal of activating the right and left atrium more synchronously. Saksena et al. There are theoretical reasons to think that pacing at a single site in the inter-atrial septum might accomplish similar atrial synchronization.
Padeletti et al. The next question is how fast to pace the atrium. Is a minimal rate required to prevent AF or is a minimal per cent atrial pacing needed? You may need a pacemaker if:. Pacemakers stimulate the heart to speed up when it beats too slowly or reset the rate when the heart beats too fast.
They can also substitute for the natural pacemaker of the heart AV or SA node. There are several risks to getting a pacemaker. But risks vary for each person. The chance of most problems is low.
The procedure to implant a pacemaker is safe, and most people do well afterward. You will see your doctor regularly to check your pacemaker and make sure you don't have any problems. During the procedure. If problems happen during the procedure, doctors can likely fix them right away. After the procedure. Problems after the procedure can be minor, like mild pain, or serious, like an infection. But your doctor can solve most of these problems. And most people do not have long-term issues with their pacemakers.
In rare cases, people feel throbbing in the neck, chest fullness, or lightheadedness when the pacemaker sends out impulses. Talk to your doctor about what types of side effects you may expect from your pacemaker. In rare cases, pacemakers are recalled by the maker of the pacemaker. A recall means that the pacemaker has a problem that needs to be watched closely or fixed. For more information on what happens if a device is recalled, see:. Author: Healthwise Staff.
Medical Review: Rakesh K. This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. Learn how we develop our content. To learn more about Healthwise, visit Healthwise. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.
Pacemaker for Atrial Fibrillation Skip to the navigation. Treatment Overview A pacemaker is a battery-powered device about the size of a pocket watch that sends weak electrical impulses to "set a pace" so that the heart is able to maintain a regular heartbeat. There are two basic types of pacemakers.
Single-chamber pacemakers stimulate one chamber of the heart, either an atrium or, more often, a ventricle. Dual-chamber pacemakers send electrical impulses to both the atrium and the ventricle and pace both chambers.
A dual-chamber pacemaker synchronizes the rhythm of the atria and ventricles in a pattern that closely resembles the natural heartbeat. What To Expect After Treatment Most people stay overnight in the hospital after they have a pacemaker implanted. Heart Problems: Living With a Pacemaker Once or twice a year your doctor will check your pacemaker and adjust it, if needed.
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