Permanent overdrive atrial pacing in the chronic management of recurrent postoperative atrial reentrant tachycardia in patients with complex congenital heart disease

P. Ragonese, F. Drago, P. Guccione, A. Santilli, M. S. Silvetti, D. A. Agostino

Research output: Contribution to journalArticle

Abstract

This study investigated the value of permanent atrial pacing as an adjunct to the current therapy in the chronic management of recurrent postoperative atrial reentrant tachycardia in patients with complex congenital heart disease. We studied the postpacing clinical course in 18 patients with recurrent atrial reentrant tachycardias unresponsive to conventional therapy who had an implanted atrial pacemaker. The pacemaker was programmed at a lower pacing rate 20% faster than the spontaneous mean daily rate previously determined with 24-hour Holter monitoring. Serial Holter recordings and pacemaker programming sessions were subsequently performed trying to mantain a paced atrial rhythm overdriving the spontaneous rhythm as long as possible. Twenty-four hour Holter monitoring documented a prevalent (> 80%) paced rhythm during the daily hours in all patients during the follow-up; all patients, however, required at least once a variation in programmed mode and pacing rate. Antiarrhythmic medications were discontinued after 6 months if the patient remained arrhythmia free while on pacing. Recurrences of atrial reentrant tachycardia occurred in five patients (29%) during the initial 6 months interval after the pacemaker implantation, while late recurrences occurred in only two patients (11%). One patient died suddenly 10 months after the pacemaker implant. At the end of the follow-up, 15 patients (83%) were arrhythmia-free and only 2 of them were still on antiarrhythmic drugs. We conclude that permanent atrial overdrive pacing can be an important tool in the management of patients with atrial reentrant tachycardia following repair of congenital heart disease.

Original languageEnglish
Pages (from-to)2917-2923
Number of pages7
JournalPACE - Pacing and Clinical Electrophysiology
Volume20
Issue number12
DOIs
Publication statusPublished - 1997

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Tachycardia
Heart Diseases
Ambulatory Electrocardiography
Cardiac Arrhythmias
Recurrence
Anti-Arrhythmia Agents
Therapeutics

Keywords

  • Permanent atrial pacing
  • Postoperative atrial tachycardias

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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title = "Permanent overdrive atrial pacing in the chronic management of recurrent postoperative atrial reentrant tachycardia in patients with complex congenital heart disease",
abstract = "This study investigated the value of permanent atrial pacing as an adjunct to the current therapy in the chronic management of recurrent postoperative atrial reentrant tachycardia in patients with complex congenital heart disease. We studied the postpacing clinical course in 18 patients with recurrent atrial reentrant tachycardias unresponsive to conventional therapy who had an implanted atrial pacemaker. The pacemaker was programmed at a lower pacing rate 20{\%} faster than the spontaneous mean daily rate previously determined with 24-hour Holter monitoring. Serial Holter recordings and pacemaker programming sessions were subsequently performed trying to mantain a paced atrial rhythm overdriving the spontaneous rhythm as long as possible. Twenty-four hour Holter monitoring documented a prevalent (> 80{\%}) paced rhythm during the daily hours in all patients during the follow-up; all patients, however, required at least once a variation in programmed mode and pacing rate. Antiarrhythmic medications were discontinued after 6 months if the patient remained arrhythmia free while on pacing. Recurrences of atrial reentrant tachycardia occurred in five patients (29{\%}) during the initial 6 months interval after the pacemaker implantation, while late recurrences occurred in only two patients (11{\%}). One patient died suddenly 10 months after the pacemaker implant. At the end of the follow-up, 15 patients (83{\%}) were arrhythmia-free and only 2 of them were still on antiarrhythmic drugs. We conclude that permanent atrial overdrive pacing can be an important tool in the management of patients with atrial reentrant tachycardia following repair of congenital heart disease.",
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AU - Drago, F.

AU - Guccione, P.

AU - Santilli, A.

AU - Silvetti, M. S.

AU - Agostino, D. A.

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