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European Heart Journal 2000 21(14):1167-1176; doi:10.1053/euhj.1999.1991
Copyright © 2000 by the European Society of Cardiology.
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Atrial pacing for suppression of early reinitiation of atrial fibrillation after successful internal cardioversion

H.-F. Tsea, C.-P. Laua,f1 and G.M. Ayersb

a Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China
b InControl Inc. Redmond, WA, U.S.A.

revised September 28, 1999; accepted October 6, 1999

Abstract

Aims To evaluate the efficacy of atrial pacing in the suppression of early reinitiation of atrial fibrillation after successful internal cardioversion.

Methods and Results The efficacy of atrial pacing in suppressing early reinitiation of atrial fibrillation was studied in 12 of 45 (29%) patients with early reinitiation of atrial fibrillation after successful cardioversion. These patients were randomized to undergo either repeated defibrillation alone or repeated defibrillation followed by high right atrial pacing at 500ms in a crossover fashion. In patients with persistent early reinitiation of atrial fibrillation despite atrial pacing at 500ms and repeated defibrillation, atrial pacing at 300ms was tested. Lastly, if early reinitiation of atrial fibrillation persisted, administration of intravenous sotalol (1·5mg.kg–1) was tested. Atrial pacing at 500ms after defibrillation prevented early reinitiation of atrial fibrillation in five of 12 (42%) patients, and was significantly more effective than repeated defibrillation (0/9 patients, 0%, P<0·05). During atrial pacing at 500ms, the density of atrial premature depolarizations (APDs) was significantly decreased (2·4±2·4APDs.min–1vs 16·4±9·8APDs.min–1, P<0·05) and the coupling interval of atrial premature depolarization was significantly increased (420±32ms vs 398±19ms,P <0·05) as compared to no pacing. In the remaining seven (58%) patients, atrial pacing at 500ms failed to prevent early reinitiation of atrial fibrillation, but significantly decreased the density of atrial premature depolarization (3·4±2·4APDs.min–1vs 14·2±4·8APDs.min–1, P<0·05) and delayed the onset of early reinitiation of atrial fibrillation (33±17s vs 11±11s, P<0·05). Atrial pacing at 300ms decreased the coupling interval of atrial premature depolarization as compared to no pacing and during atrial pacing at 500ms (P<0·05), but without early reinitiation of atrial fibrillation suppression. Administration of intravenous sotalol was effective in preventing early reinitiation of atrial fibrillation in five of seven (71%) patients where pacing failed to suppress early reinitiation of atrial fibrillation.

Conclusion The results of this study suggest that atrial pacing can be useful when combined with transvenous defibrillation in patients with early reinitiation of atrial fibrillation.

Key Words: Atrial pacing, internal cardioversion, atrial fibrillation

f1 Correspondence: Chu-Pak Lau, MD, Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China.

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