Atrial pacing has been widely but intermittently reported to reduce the recurrence of atrial fibrillation (AF) and progression to permanent AF in a wide variety of observational reports, with the vast majority of these involving retrospective analyses [1–3]. In addition, a variable patient population with respect to AF and underlying cardiac disease has often characterized these reports. The subject has received substantial attention since the follow-up report of the Danish Trial of Physiologic Pacing in sick sinus syndrome reported reduction in the incidence of persistent or permanent AF with atrial-based pacing in patients with sick sinus syndrome [4]. Clinical investigation of atrial pacing techniques for management of AF in symptomatic or high-risk populations has been examined in a series of prospective clinical trials [5–9]. Serious investigative interest has now focused on the electrophysiologic effects of different atrial pacing methods in experimental and clinical laboratory AF models. Analysis of the benefit of atrial pacing is complicated by the interactions of this apparently simple intervention with a heterogeneous AF population and our limited knowledge of the natural history of the arrhythmia in its different substrates. Finally, the appropriate endpoints for demonstration of device clinical efficacy and safety have been unclear, leading to increasing difficulty in defining and quantifying clinical benefit [10, 11].

S. Saksena

Papers

Atrial Pacing to Prevent Atrial Fibrillation: Is There Any Evidence of Its Real Efficacy?