Clinical application of pacemakers in atrial tachyarrhythmias

In principle, pacemakers (PM) are indicated for the treatment of bradycardia-related symptoms and nowadays also for the resynchronisation of the failing left ventricle. In sick sinus syndrome, atrial tachyarrhythmias (ATAs) frequently emerge. Experience shows that the hybrid approach of standard atrial pacing with AAI(R) or DDD(R) and pharmacological treatment is useful to suppress ATAs in sick sinus syndrome. These results, the growing number of patients with ATAs with different aetiologies and the limited (long-term) success rates of catheter ablative methods of the source of ATAs, recently triggered the technical development of pacing algorithms. These recognise, classify and diagnose ATAs and deliver specific atrial pacing sequences for preventing and/or interrupting ATAs. Recent large-scale studies demonstrate ambiguous results, but all show that additional pharmacological treatment remains indispensable in obtaining benefit. This overview addresses some characteristics of these pacing algorithms, including PM diagnostics and programming as well as discusses the role of the atrial pacing site and configuration of atrial pacing leads. …