Abstract
DDD pacing is not suitable in the presence of chronic atrial flutter or fibrillation. 1 However, patients with the bradycardia-tachycardia syndrome who mostly are in sinus rhythm may be considered for DDD pacing, although bradycardia control does not completely prevent further paroxysms of atrial tachyarrhythmia. 2 Even in patients without a history of attacks, future episodes of atrial flutter or fibrillation cannot be excluded at the time of implantation. 3,4 Atrial flutter may then be terminated by rapid overdrive stimulation, 5 which usually has to be performed through an additional temporary transvenous electrode catheter. However, in some dual chamber pacemakers the atrial and ventricular asynchronous modes (AOO and VOO) can be programmed to very high rates on a temporary basis “for use in clinical diagnostic settings to control and terminate episodes of tachycardia.” 6 This approach may also be suitable for converting atrial flutter to sinus rhythm without the need for additional transvenous lead insertion.
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