Can linear triple-site atrial pacing reinforce the electrical treatment of atrial fibrillation?

Abstract

This editorial refers to ‘Atrial activation time and pattern of linear triple-site vs. single-site atrial pacing after cardioversion in patients with atrial fibrillation’ by J.-I. Choi et al., on page 508. In their recent editorial commentary on the role of atrial pacing in prevention or interruption of atrial tachyarrhythmias, Janko and Hoffmann1 have concluded that today this treatment is of the arbitrary value and finished off with the statement ‘do we still need to talk about it?’ Indeed, despite more than a decade of significant intellectual investments and numerous clinical trials exploring a vast spectrum of pacing algorithms, pacing sites, and lead configurations, the majority of published data indicate unsatisfying short- or mid-term prevention or suppression of atrial fibrillation (AF) and atrial tachycardia (AT). The reasons for these poor results have been well documented and include: (i) the inability to adequately suppress predominantly left atrial sided triggers and/or penetrate the initial circulatory wave fronts, (ii) delayed interruption of AT/AF because of time needed for classifying and confirming the type of the already ongoing and nested atrial tachyarrhythmias, and (iii) incorrect pattern recognition. Most serious of all, adverse effects of inappropriate antitachycardia or overdrive pacing by provoking AT/AF instead of suppressing or preventing the arrhythmia due to incorrect or not timely diagnosis often emerge. Presently, classical sick sinus syndrome with a low incidence of paroxysmal AT/AF remains the best indication for this electrical therapy while patients with … *Corresponding author. Tel: +31 817559801; fax: +31 302516396, Email: n.m.vanhemel{at}hetnet.nl