Can progression to permanent atrial fibrillation be prevented by pacing?

Abstract

This editorial refers to ‘Atrial antitachycardia pacing and managed ventricular pacing in bradycardia patients with paroxysmal or persistent atrial tachyarrhythmias: the MINERVA randomized multicentre international trial’, by G. Boriani et al. , doi:10.1093/eurheartj/ehu165 The optimal pacing mode in patients with bradycardia has been searched for through a series of randomized controlled trials performed within the last two decades. It is well documented, and easy to understand, that single lead ventricular pacing disrupting the normal atrioventricular synchrony is associated with a higher incidence of atrial fibrillation (AF) than dual chamber pacing (DDD) preserving atrioventricular synchrony. Furthermore, in patients with sinus node dysfunction, prevention of AF seems to depend on a delicate balance between the avoidance of excess ventricular pacing and the avoidance of excessively long atrioventricular intervals, both factors promoting the occurrence of AF.1,2 Some previous studies have indicated an effect of atrial pacing algorithms in preventing AF. However, the majority of randomized trials investigating these algorithms showed no convincing effect on reducing AF,3,4 and the use of such algorithms is not recommended in the most recent guidelines on cardiac pacing. The MINERVA randomized trial investigated the effect of a combination of preventive atrial pacing algorithms, different antitachycardia atrial pacing algorithms, and managed ventricular pacing (MVP) to minimize ventricular pacing in the subgroup of patients with bradycardia and indication for DDD pacing, who had paroxysmal or persistent atrial tachyarrhythmia without complete atrioventricular block.5 …