How Would We Prevent Paroxysmal Atrial Fibrillation Attacks Secondary to Bradicardia?

Öz

OBJECTIVE: The incidence of chronic diseases increases along with the extension of the life of humans day by day. One of them is a paroxysmal atrial fibrillation (PAF). However, there has been no accurate treatment method for PAF yet and the most commonly applied method is radiofrequency isolation of pulmonary veins. But still alternative treatment approaches are needed. For this reason we implanted dual-chamber, rate-modulated pacing (DDDR) pacemaker in patients with PAF secondary to bradycardia and evaluated the frequency of PAF attacks.METHODS: For this reason 54 patients with acute AF who had at least two PAF attacks within the last year were enrolled our study. After converting the cardiac rhythms of the patients to sinus rhythm, rhythm holter device was connected to the patients within first 48 hours. Patients with average heart rate RESULTS: The mean age of patients were 60±15.5 years. Mean left atrium diameter was measured as 42.4±6.3 mm. The rate of PAF was significantly higher in patients with coronary artery disease or mitral valve disease as compared to those without these diseases (41.7% vs 28.57% and 44.4% vs 28.9%, respectively), (p

Anahtar Kelimeler

• Bradycardia, paroxysmal atrium fibrillation; pacemaker.

Bradikardiye Sekonder Paroksismal Atriyum Fibrilasyonu Ataklarını Nasıl Önleriz?

Öz

AMAÇ: Her geçen gün insan ömrünün uzaması ile birlikte kronik hastalıkların da görülme sıklığı artmaktadır. Bunlardan biri de paroksismal atriyum fibrilasyonu (PAF)'dur. Ne var ki PAF tedavisinde etkin bir yöntem henüz belirlenmiş olmayıp, sık uygulanan tedavilerin başında pulmoner ven izolasyonu gelmektedir, ancak bu yönteme rağmen alternatif tedavi yaklaşımlarına ihtiyaç duyulmaktadır. Dolayısıyla bradikardiye sekonder PAF hastalarına DDDR (dual-chamber, rate-modulated pacing) "pacemaker" implantasyonu yaparak PAF atak sıklığını değerlendirmek istedik.YÖNTEMLER: Bu amaçla son bir yıl içerisinde en az iki kez PAF atağı olan toplam 54 akut AF'lı hasta çalışmaya dâhil edildi. Tüm hastaların ritimleri sinüs ritmine çevrildikten sonra 48 saat içerisinde hastalara ritim holteri takıldı. Ortalama kalp hızları BULGULAR: Hastaların yaş ortalaması 60±15,5 yıl idi. Ortalama sol atriyum çapı 42,4±6,3 mm olarak ölçüldü. Koroner arter hastalığı veya mitral kapak hastalığı bulunanlarda bulunmayanlara oranla PAF'a girme oranı anlamlı oranda daha yüksek bulundu. (sırasıyla %41,7'ye %28,57 ve %44,4'e %28,9), (p

Anahtar Kelimeler

• Bradikardi, paroksismal atriyum fibrilasyonu; pacemaker

Kaynakça

1. Hoffman C, Rice D, Sung HY. Persons with chronic conditions. Their prevalence and costs. JAMA 1996;276:1473-9.
2. Jones SA. Ageing to arrhythmias: conundrums of connections in the ageing heart. J Pharm Pharmacol 2006;58:1571-6.
3. Vogler J, Breithardt G, Eckardt L. Bradyarrhythmias and conduction blocks. Rev Esp Cardiol (Engl Ed) 2012;65:656-67.
4. Colilla S, Crow A, Petkun W, Singer DE, Simon T, Liu X. Estimates of Current and Future Incidence and Prevalence of Atrial Fibrillation in the U.S. adult population. Am J Cardiol 2013;112:1142-7.
5. Chen J, Todd DM, Hocini M, Larsen TB, Bongiorni MG, Blomström- Lundqvist C; Conducted by the Scientific Initiative Committee, European Heart Rhythm Association. Current periprocedural management of ablation for atrial fibrillation in Europe: results of the European Heart Rhythm Association survey. Europace 2014;16:378-81.
6. Aldhoon B, Wichterle D, Peichl P, Čihák R, Kautzner J. Complications of catheter ablation for atrial fibrillation in a high-volume centre with the use of intracardiac echocardiography. Europace 2013;15:24-32.
7. Ganesan AN, Shipp NJ, Brooks AG, Kuklik P, Lau DH, Lim HS. Long-term outcomes of catheter ablation of atrial fibrillation: a systematic review and meta-analysis. Am Heart Assoc 2013;2:e004549.
8. Masuda M, Inoue K, Iwakura K, Okamura A, Toyoshima Y, Doi A, et al. Impact of pulmonary vein isolation on atrial late potentials: association with the recurrence of atrial fibrillation. Europace 2013;15:501-7.

9. Vogt J, Heintze J, Gutleben KJ, Muntean B, Horstkotte D, Nölker G. Long- term outcomes after cryoballoon pulmonary vein isolation: results from a prospective study in 605 patients. J Am Coll Cardiol 2013;23;61:1707-12.
10. Packer DL, Kowal RC, Wheelan KR, Irwin JM, Champagne J, Guerra PG, et al. STOP AF Cryoablation Investigators. Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation: first results of the North American Arctic Front (STOP AF) pivotal trial. J Am Coll Cardiol 2013;61:1713-23.
11. Jongnarangsin K, Suwanagool A, Chugh A, Crawford T, Good E, Pelosi F Jr, et al. Effect of catheter ablation on progression of paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 2012;23:9-14.
12. Schuchert A. Contributions of permanent cardiac pacing in the treatment of atrial fibrillation. Europace 2004;5(Suppl 1):36-41.
13. Kantharia BK, Freedman RA, Hoekenga D, Tomassoni G, Worley S, Sorrentino R, et al. AOP Study Investigators. Increased base rate of atrial pacing for prevention of atrial fibrillation after implantation of a dual- chamber pacemaker: insights from the Atrial Overdrive Pacing Study. Europace 2007;9:1024-30.
14. Saksena S, Prakash A, Ziegler P, Hummel JD, Friedman P, Plumb VJ, et al. DAPPAF Investigators Improved suppression of recurrent atrial fibrillation with dual-site right atrial pacing and antiarrhythmic drug therapy. J Am Coll Cardiol 2002;40:1140-50.
15. Delfaut P, Saksena S, Prakash A, Krol RB. Long-term outcome of patients with drug-refractory atrial flutter and fibrillation after single and dual- site right atrial pacing for arrhythmia prevention. J Am Coll Cardiol 1998;32:1900-8.
16. Carlson MD, Ip J, Messenger J, Beau S, Kalbfleisch S, Gervais P, et al. Atrial Dynamic Overdrive Pacing Trial (ADOPT) Investigators. Atrial Dynamic Overdrive Pacing Trial (ADOPT) Investigators. A new pacemaker algorithm for the treatment of atrial fibrillation: results of the Atrial Dynamic Overdrive Pacing Trial (ADOPT). J Am Coll Cardiol 2003;42:627-33.
17. Padeletti L, Pürerfellner H, Adler SW, Waller TJ, Harvey M, Horvitz L, et al. Worldwide ASPECT Investigators. Combined efficacy of atrial septal lead placement and atrial pacing algorithms for prevention of paroxysmal atrial tachyarrhythmia. J Cardiovasc Electrophysiol 2003;14:1189-95.
18. de Voogt W, van Hemel N, de Vusser P, Mairesse GH, van Mechelen R, Koistinen J, et al. Atrial fibrillation suppression reduces atrial fibrillation burden on patients with paroxysmal atrial fibrillation and class 1&2 pacemaker indication, the OASES study. Eur Heart J 2003;24:369.
19. Ward KJ, Willett JE, Bucknall C, Gill JS, Kamalvand K. Atrial arrhythmia suppression by atrial overdrive pacing: pacemaker Holter assessment. Europace 2001;3:108-14.
20. Attuel P, Pellerin D, Mugica J, Coumel P. DDD pacing: an effective treatment modality for recurrent atrial arrhythmias. Pacing Clin Electrophysiol 1988;11:1647-54.
21. Murgatroyd FD, Nitzsché R, Slade AK, Limousin M, Rosset N, Camm AJ, et al. A new pacing algorithm for overdrive suppression of atrial fibrillation. Chorus Multicentre Study Group. Pacing Clin Electrophysiol 1994;17:1966-73.
22. Garrigue S, Barold SS, Cazeau S, Gencel L, Jaïs P, Haissaguerre M, et al. Prevention of atrial arrhythmias during DDD pacing by atrial overdrive. Pacing Clin Electrophysiol 1998;21:1751-9.
23. Stabile G, Senatore G, De Simone A, Turco P, Coltorti F, Nocerino P, et al. Determinants of efficacy of atrial pacing in preventing atrial fibrillation recurrences. J Cardiovasc Electrophysiol 1999;10:2-9.
24. Israel CW, Lawo T, Lemke B, Gronefeld G, Hohnloser SH. Atrial pacing in the prevention of paroxysmal atrial fibrillation: first results of a new combined algorithm. Pacing Clin Electrophysiol 2000;23:1888-90.
25. Funck RC, Adamec R, Lurje L, Capucci A, Ritter P, Shekan D, et al. Prevention by Overdriving. Atrial overdrive is beneficial in patients with atrial arrhythmias: first results of the PROVE study. Pacing Clin Electrophysiol 2000;23:1891-3.