Skip to main content

Advertisement

SpringerLink
Log in

Stellenwert der Herzschrittmacher-Therapie bei der Vorhofflimmer-Prophylaxe

The role of cardiac pacing in atrial arrhythmia prevention

  • Published:
Zeitschrift für Kardiologie Aims and scope Submit manuscript

Summary

Pathophysiological considerations, animal data and acute clinical tests suggest some benefit of cardiac pacing in the prevention of paroxysmal atrial tachyarrhythmia. While early clinical studies confirm this notion, data of randomized prospective trials at least are mixed. The equivocal effects of using alternative atrial pacing sites and/or dedicated preventive pacing algorithms leaves the question of how to predict the beneficial effect of antitachycardia pacing strategies in the individual patient. Since the answer is lacking, the mere intention to prevent atrial arrhythmias is not a valid pacing indication. Pacing for the bradycardia tachycardia syndrome, however, may benefit from preventive techniques in individual cases.

Zusammenfassung

Pathophysiologische Überlegungen, tierexperimentelle und klinische Kurzzeituntersuchungen sprechen der kardialen Stimulationsbehandlung das Potential zu, paroxysmalem Vorhofflimmern wirksam vorbeugen zu können. Wurde dies in ersten klinischen Tests noch bestätigt, so ist die Erfahrung aus prospektiv randomisierten Studien weniger eindeutig. Die heterogenen Befunde zum Einfluss des Stimulationsorts im Vorhof und zur Wirksamkeit präventiver Stimulationsalgorithmen auf den spontanen Krankheitsverlauf provozieren die Frage, wer vom Einsatz eines Schrittmachers zur Prophylaxe des Vorhofflimmerns profitiert und an welchen Prädiktoren dies zu erkennen ist. Solange die Antwort aussteht, ist die Flimmerprävention allein keine gültige Indikation zur Schrittmacherimplantation. Beim Bradykardie-Tachykardie-Syndrom jedoch kann die Erweiterung der antibradykarden Stimulation durch präventive Techniken individuell erfolgreich sein.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Andersen HR, Nielsen JC, Thomsen PE, Thuesen L, Mortensen PT, Vesterlund T, Pedersen AK (1997) Long-term follow-up of patients from a randomised trial of atrial versus ventricular pacing for sick-sinus syndrome. Lancet 350:1210–1216

    Article  CAS  PubMed  Google Scholar 

  2. Arentz T, Ott P, von Rosenthal J, Blum T, Kalusche D (2003) Effect of atrial overdrive pacing on pulmonary vein focal discharge in patients with atrial fibrillation. Europace 5:25–31

    Article  CAS  PubMed  Google Scholar 

  3. Bailin SJ, Adler S, Giudici M (2001) Prevention of chronic atrial fibrillation by pacing in the region of Bachmann’s bundle: results of a multicenter randomized trial. J Cardiovasc Electrophysiol 12:912–917

    Article  CAS  PubMed  Google Scholar 

  4. Becker R, Klinkott R, Bauer A, Senges JC, Schreiner KD, Voss F, Kuebler W, Schoels W (2000) Multisite pacing for prevention of atrial tachyarrhythmias: potential mechanisms. J Am Coll Cardiol 35:1939–1946

    Article  CAS  PubMed  Google Scholar 

  5. Becker R, Senges JC, Bauer A, Schreiner KD, Voss F, Kuebler W, Schoels W (2002) Suppression of atrial fibrillation by multisite and septal pacing in a novel experimental model. Cardiovasc Res 54:476–481

    Article  CAS  PubMed  Google Scholar 

  6. Blanc JJ, De Roy L, Mansourati J, Poezevara Y, Marcon JL, Schoels W, Hidden-Lucet F, Barnay C (2004) Atrial pacing for prevention of atrial fibrillation: assessment of simultaneously implemented algorithms. Europace 6:371–379

    Article  PubMed  Google Scholar 

  7. Brignole M, Gianfranchi L, Menozzi C, Alboni P, Musso G, Bongiorni MG, Gasparini M, Raviele A, Lolli G, Paparella N, Acquarone S (1997) Assessment of atrioventricular junction ablation and DDDR mode-switching pacemaker versus pharmacological treatment in patients with severely symptomatic paroxysmal atrial fibrillation: a randomized controlled study. Circulation 96:2617–2624

    CAS  PubMed  Google Scholar 

  8. Carlsson J, Miketic S, Windeler J, Cuneo A, Haun S, Micus S, Walter S, Tebbe U (2003) Randomized trial of rate-control versus rhythm-control in persistent atrial fibrillation: the Strategies of Treatment of Atrial Fibrillation (STAF) study. J Am Coll Cardiol 41:1690–1696

    Article  PubMed  Google Scholar 

  9. D’Allonnes GR, Pavin D, Leclercq C, Ecke JE, Jauvert G, Mabo P, Daubert JC (2000) Long-term effects of biatrial synchronous pacing to prevent drug-refractory atrial tachyarrhythmia: a nine-year experience. J Cardiovasc Electrophysiol 11:1081–1091

    CAS  PubMed  Google Scholar 

  10. De Vusser P, Stockman D, van den Bos A et al (2004) AF suppression reduces AF burden on patients with paroxysmal AF and class 1 and 2 pacemaker indication—The OASES study. Europace 4 (Suppl B):B65 (abst)

    Google Scholar 

  11. Delfaut P, Saksena S, Prakash A, Krol RB (1998) Long-term outcome of patients with drug-refractory atrial flutter and fibrillation after single- and dual-site right atrial pacing for arrhythmia prevention. J Am Coll Cardiol 32:1900–1908

    Article  CAS  PubMed  Google Scholar 

  12. Duytschaever M, Danse P, Eysbouts S, Allessie M (2002) Is there an optimal pacing site to prevent atrial fibrillation?: an experimental study in the chronically instrumented goat. J Cardiovasc Electrophysiol 13:1264–1271

    PubMed  Google Scholar 

  13. Duytschaever M, Firsovaite V, Colpaert R, Allessie M, Tavernier R (2005) Limited benefit of septal preexcitation in pace prevention of atrial fibrillation. J Cardiovasc Electrophysiol 16:269–277

    Article  PubMed  Google Scholar 

  14. Gillis AM, Wyse DG, Connolly SJ, Dubuc M, Philippon F, Yee R, Lacombe P, Rose MS, Kerr CD (1999) Atrial pacing periablation for prevention of paroxysmal atrial fibrillation. Circulation 99:2553–2558

    CAS  PubMed  Google Scholar 

  15. Gregoratos G, Abrams J, Epstein AE, Freedman RA, Hayes DL, Hlatky MA, Kerber RE, Naccarelli GV, Schoenfeld MH, Silka MJ, Winters SL (2002) ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices–summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/NASPE Committee to Update the 1998 Pacemaker Guidelines). J Am Coll Cardiol 40:1703–1719

    Article  PubMed  Google Scholar 

  16. Israel CW, Gronefeld G, Ehrlich JR, Li YG, Hohnloser SH (2003) Prevention of immediate reinitiation of atrial tachyarrhythmias by high-rate overdrive pacing: results from a prospective randomized trial. J Cardiovasc Electrophysiol 14:954–959

    Article  PubMed  Google Scholar 

  17. Israel CW, Hugl B, Unterberg C, Lawo T, Kennis I, Hettrick D, Hohnloser SH (2001) Pace-termination and pacing for prevention of atrial tachyarrhythmias: results from a multicenter study with an implantable device for atrial therapy. J Cardiovasc Electrophysiol 12:1121–1128

    Article  CAS  PubMed  Google Scholar 

  18. Kerr CR, Connolly SJ, Abdollah H, Roberts RS, Gent M, Yusuf S, Gillis AM, Tang AS, Talajic M, Klein GJ, Newman DM (2004) Canadian Trial of Physiological Pacing: Effects of physiological pacing during long-term follow-up. Circulation 109:357–362

    Article  PubMed  Google Scholar 

  19. Knight BP, Gersh BJ, Carlson MD, Friedman PA, McNamara RL, Strickberger SA, Tse HF, Waldo AL (2005) Role of permanent pacing to prevent atrial fibrillation: science advisory from the American Heart Association Council on Clinical Cardiology (Subcommittee on Electrocardiography and Arrhythmias) and the Quality of Care and Outcomes Research Interdisciplinary Working Group, in collaboration with the Heart Rhythm Society. Circulation 111:240–243

    Article  PubMed  Google Scholar 

  20. Lamas GA, Lee KL, Sweeney MO, Silverman R, Leon A, Yee R, Marinchak RA, Flaker G, Schron E, Orav EJ, Hellkamp AS, Greer S, McAnulty J, Ellenbogen K, Ehlert F, Freedman RA, Estes NA, III, Greenspon A, Goldman L (2002) Ventricular pacing or dual-chamber pacing for sinus-node dysfunction. N Engl J Med 346:1854–1862

    Article  PubMed  Google Scholar 

  21. Lau CP, Tse HF, Yu CM, Teo WS, Kam R, Ng KS, Huang SS, Lin JL, Fitts SM, Hettrick DA, Hill MR (2001) Dual-site atrial pacing for atrial fibrillation in patients without bradycardia. Am J Cardiol 88:371–375

    Article  CAS  PubMed  Google Scholar 

  22. Lee MA, Weachter R, Pollak S, Kremers MS, Naik AM, Silverman R, Tuzi J, Wang W, Johnson LJ, Euler DE (2003) The effect of atrial pacing therapies on atrial tachyarrhythmia burden and frequency: results of a randomized trial in patients with bradycardia and atrial tachyarrhythmias. J Am Coll Cardiol 41:1926–1932

    PubMed  Google Scholar 

  23. Levy T, Walker S, Rex S, Rochelle J, Paul V (2001) No incremental benefit of multisite atrial pacing compared with right atrial pacing in patients with drug refractory paroxysmal atrial fibrillation. Heart 85:48–52

    CAS  PubMed  Google Scholar 

  24. Lewalter T, Yang A, Saborowski F, Pfeiffer D, Markert T, Schrickel J, Schwab JO, Bielik H, Bitzen A, Lüderitz B (2003) Pacing for the prevention of recurrent atrial fibrillation: results from the VIP registry. Circulation 108:IV-709 (abst)

    Google Scholar 

  25. Mabo P, Daubert JC, Bouhour A (1999) Biatrial synchronous pacing for atrial arrhythmia prevention: The SYNBIAPACE study. Pacing and Clinical Electrophysiology 22:755 (abst)

    Google Scholar 

  26. Murgatroyd FD, Nitzsche R, Slade AK, Limousin M, Rosset N, Camm AJ, Ritter P (1994) A new pacing algorithm for overdrive suppression of atrial fibrillation. Chorus Multicentre Study Group. Pacing Clin Electrophysiol 17:1966–1973

    CAS  PubMed  Google Scholar 

  27. Nielsen JC, Kristensen L, Andersen HR, Mortensen PT, Pedersen OL, Pedersen AK (2003) A randomized comparison of atrial and dual-chamber pacing in 177 consecutive patients with sick sinus syndrome: echocardiographic and clinical outcome. J Am Coll Cardiol 42:614–623

    Article  PubMed  Google Scholar 

  28. Padeletti L, Purerfellner H, Adler S, Waller T, Harvey MN, Horvitz L, Mugglin A, Kempen K, Holbrook R, Hettrick D (2002) Atrial septal lead placement and atrial pacing algorithms for prevention of paroxysmal atrial fibrillation: ASPECT study results. Pacing Clin Electrophysiol 24:687–687

    Google Scholar 

  29. Padeletti L, Pieragnoli P, Ciapetti C, Colella A, Musilli N, Porciani MC, Ricci R, Pignalberi C, Santini M, Puglisi A, Azzolini P, Spampinato A, Martelli M, Capucci A, Boriani G, Botto G, Proclemer A (2001) Randomized crossover comparison of right atrial appendage pacing versus interatrial septum pacing for prevention of paroxysmal atrial fibrillation in patients with sinus bradycardia. Am Heart J 142:1047–1055

    Article  CAS  PubMed  Google Scholar 

  30. Padeletti L, Purerfellner H, Adler SW, Waller TJ, Harvey M, Horvitz L, Holbrook R, Kempen K, Mugglin A, Hettrick DA (2003) Combined efficacy of atrial septal lead placement and atrial pacing algorithms for prevention of paroxysmal atrial tachyarrhythmia. J Cardiovasc Electrophysiol 14:1189–1195

    Article  PubMed  Google Scholar 

  31. Papageorgiou P, Anselme F, Kirchhof CJ, Monahan K, Rasmussen CA, Epstein LM, Josephson ME (1997) Coronary sinus pacing prevents induction of atrial fibrillation. Circulation 96:1893–1898

    CAS  PubMed  Google Scholar 

  32. Papageorgiou P, Monahan K, Boyle NG, Seifert MJ, Beswick P, Zebede J, Epstein LM, Josephson ME (1996) Site-dependent intra-atrial conduction delay. Relationship to initiation of atrial fibrillation. Circulation 94:384–389

    CAS  PubMed  Google Scholar 

  33. Puglisi A, Altamura G, Capestro F, Castaldi B, Critelli G, Favale S, Pavia L, Pettinati G (2003) Impact of Closed-Loop Stimulation, overdrive pacing, DDDR pacing mode on atrial tachyarrhythmia burden in Brady-Tachy Syndrome. A randomized study. Eur Heart J 24:1952–1961

    Article  CAS  PubMed  Google Scholar 

  34. Reithmann C, Dorwarth U, Gerth A, Remp T, Steinbeck G, Hoffmann E (2001) Early reinitiation of atrial fibrillation following external electrical cardioversion in amiodarone-treated patients. J Interv Card Electrophysiol 5:285–292

    Article  CAS  PubMed  Google Scholar 

  35. Ricci R, Santini M, Puglisi A, Azzolini P, Capucci A, Pignalberi C, Boriani G, Botto GL, Spampinato A, Bellocci F, Proclemer A, Grammatico A, de Seta F (2001) Impact of consistent atrial pacing algorithm on premature atrial complexe number and paroxysmal atrial fibrillation recurrences in brady-tachy syndrome: a randomized prospective cross over study. J Interv Card Electrophysiol 5:33–44

    Article  CAS  PubMed  Google Scholar 

  36. Saksena S, Prakash A, Ziegler P, Hummel JD, Friedman P, Plumb VJ, Wyse DG, Johnson E, Fitts S, Mehra R (2002) Improved suppression of recurrent atrial fibrillation with dualsite right atrial pacing and antiarrhythmic drug therapy. J Am Coll Cardiol 40:1140–1150

    Article  PubMed  Google Scholar 

  37. Schuchert A, Bub E, Braun M, Rebeski HP, Kroll W, Aydin MA, Mortensen K (2004) Reduktion des AF-burden bei Schrittmacherpatienten mit paroxysmalem Vorhofflimmern mit getriggerter gegenüber getriggerter plus kontinuierlicher Vorhofstimulation. Z Kardiol 93 (Suppl.B):III/286 (abst)

    Google Scholar 

  38. Seidl KH, Cazeau S, Gaita F, Mabo P, Bocchiardo M, Blanc JJ, Poezevara Y, Anselme F (2002) Dual-site pacing vs mono-site pacing in prevention of atrial fibrillation. Pacing Clin Electrophysiol 24:568 (abst)

    Google Scholar 

  39. Sweeney MO, Hellkamp AS, Ellenbogen KA, Greenspon AJ, Freedman RA, Lee KL, Lamas GA (2003) Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation 107:2932–2937

    Article  PubMed  Google Scholar 

  40. Toff WD, Camm AJ, Skehan JD (2005) Single-chamber versus dual-chamber pacing for high-grade atrioventricular block. N Engl J Med 353:145–155

    Article  CAS  PubMed  Google Scholar 

  41. Tse HF, Lau CP, Ayers GM (2000) Atrial pacing for suppression of early reinitiation of atrial fibrillation after successful internal cardioversion. Eur Heart J 21:1167–1176

    Article  CAS  PubMed  Google Scholar 

  42. Wiberg S, Lonnerholm S, Jensen SM, Blomstrom P, Ringqvist I, Blomstrom-Lundqvist C (2003) Effect of right atrial overdrive pacing in the prevention of symptomatic paroxysmal atrial fibrillation: a multicenter randomized study, the PAF-PACE study. Pacing Clin Electrophysiol 26:1841–1848

    Article  PubMed  Google Scholar 

  43. Yu WC, Tsai CF, Hsieh MH, Chen CC, Tai CT, Ding YA, Chang MS, Chen SA (2000) Prevention of the initiation of atrial fibrillation: mechanism and efficacy of different atrial pacing modes. Pacing Clin Electrophysiol 23:373–379

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Universität des Saarlandes, Medizinische Klinik und Poliklinik III, Kirnbergerstraße, 66424, Homburg/Saar

    G. Fröhlig

Authors
  1. G. Fröhlig
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fröhlig, G. Stellenwert der Herzschrittmacher-Therapie bei der Vorhofflimmer-Prophylaxe. ZS Kardiologie 94 (Suppl 4), iv53–iv59 (2005). https://doi.org/10.1007/s00392-005-1413-9

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-005-1413-9

Key words

Schlüsselwörter

Search

Navigation