Abstract
Sustained atrial tachycardias occurring after surgery for congenital heart disease, are often difficult to control by antiarrhythmic drugs and by antitachycardia pacing. We implanted a permanent pacing system in 11 pts with drug resistant recurrent atrial reentrant tachycardias. 7 pts were male and 4 female; mean age was 7.4 years (range 1 to 28 yrs); mean time from surgery to the first documented atrial tachycardia was 2.2 years (range 1 month to 9 yrs). All pts had been unsuccessfully treated with two to five antiarrhythmic drugs before pacing. At implantation the atrial pacing rate was programmed to be 20% faster than the mean diurnal spontaneous rate. Individualized programs of pacemaker rate settings were then selected following serial 24 hours Holter monitoring, to obtain a prevailing paced atrial rhythm. Mean follow-up was 3.4 years (range 6 mos to 5 yrs). 3 pts had recurrences of atrial tachycardia during the first six months after the implantation, 8 pts remained arrhythmia free. No patient had late recurrences and only two are still on antiarrhythmic drug therapy. In conclusion : permanent overdrive atrial pacing is a very useful tool in chronic management of postoperative atrial reentrant tachycardias.
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