Comparison of atrial overdrive pacing with and without extrastimuli for termination of atrial flutter

• Published in: The American journal of cardiology Vol. 70; no. 4; pp. 463 - 467
• Main Authors: Hii, John T.Y., Mitchell, L.Brent, Duff, Henry J., Wyse, D.George, Gillis, Anne M.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 15.08.1992; Elsevier
• Subjects: Aged; Arrhythmias, Cardiac - etiology; Atrial Flutter - therapy; Biological and medical sciences; Cardiac dysrhythmias; Cardiac Pacing, Artificial - adverse effects; Cardiac Pacing, Artificial - methods; Cardiology. Vascular system; Female; Heart; Humans; Male; Medical sciences; Middle Aged; Human; Atrium; Instrumental stimulation; Arrhythmia; Instrumentation therapy; Cardiovascular disease; Technique; Excitability disorder; Comparative study; Atrial flutter
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/0002-9149(92)91191-6

Atrial overdrive pacing has been successfully used to terminate atrial flutter. This study compared the efficacy of atrial extrastimuli following a rapid pacing train to overdrive pacing without atrial extrastimuli for the termination of atrial flutter. Patients were randomized to treatments of short or long burst atrial overdrive pacing or atrial overdrive pacing followed by atrial extrastimuli in a crossover study design. A total of 22 patients (73%) had successful conversion of atrial flutter to sinus rhythm. The success rates in patients exposed to each therapy, including crossover therapies, were 62% with the atrial extrastimuli method, 8% with the short burst pacing method, and 8% with the long burst pacing method (p <0.001). Transient atrial fibrillation developed in 15 patients and in 9 of these thyis arrhythmia preceded conversion to sinus rhythm. Sustained atrial fibrillation was induced in 3 additional patients but never with the atrial extrastimuli method. In conclusion, the method of delivering atrial extrastimuli after a rapid pacing train is highly efficacious for the termination of atrial flutter. Furthermore, this method is more effective than atrial overdrive pacing methods delivered at the same pacing cycle length. These observations have important implications for the programming of antitachycardia pacemakers.