RT-149
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Are paroxysmal atrial flutter or
fibrillation at the time of implantation absolute contraindications for implantation of a
dual chamber pacemaker?
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Domenico Zanuttini, Fabio Zardo,
Marco Brieda, Nereo Meneguzzo, Enzo Hrovatin, Delia Zadnik.
Department of Cardiology-ARC, Azienda Sanitaria "S.M. degli Angeli",
Pordenone, Italy
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Abstract
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The use of dual chamber pacemakers (DDD) is considered
the most physiologic mode of stimulation. In brady-tachy syndrom the frequent recurrence
of paroxysmal atrial flutter (AF) or atrial fibrillation (af) are reduced with DDD
pacemaker as compared to VVI mode of stimulation.
However previous episodes of AF or af contraindicate a DDD pacemaker also in patients
in sinus rhythm at the time of implantation. At present authors suggested that paroxysmal
atrial arrhythmias should not absolutely preclude implantation of a dual chamber
pacemaker.
In this paper we reported 14 patients with symptomatic brady-arrhythmias and in sinus
rhythm who where treated with a dual chamber pacemaker despite the presence of AF or af
suddenly developed at the time of implantation and in whom atrial lead was implanted in
absence of available pacing and sensing thresholds.
During the long-term follow-up (39 ± 20 m., range 10-67 m.) 11 patients remained
asymptomatic, 2 patients complained palpitations but atrial arrhythmias could be
documented by Holter monitoring, and, in only one case, paroxysmal atrial arrhythmia
caused a downgrading from DDD to VVI mode of stimulation until the pharmacologic
restoration of sinus rhythm.
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Key Words
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Atrial fibrillation – RF catheter ablation
of AV junction
paroxysmal AF, brady-tachy syndrome, pacemaker (DDD, VVI mode), OA
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