PMID- 2471162
OWN - NLM
STAT- MEDLINE
DCOM- 19890706
LR  - 20190726
IS  - 0147-8389 (Print)
IS  - 0147-8389 (Linking)
VI  - 12
IP  - 5
DP  - 1989 May
TI  - Chronic rapid atrial pacing to maintain atrial fibrillation: use to permit 
      control of ventricular rate in order to treat tachycardia induced cardiomyopathy.
PG  - 761-75
AB  - LR was a patient, followed over a 16-year period, who presented with an atrial 
      tachycardia which was initially intermittent, but became incessant. Neither the 
      atrial tachycardia nor the associated rapid ventricular response rate could be 
      treated successfully with available drug therapy, resulting in a dilated 
      cardiomyopathy and New York Heart Association (NYHA) class III-IV congestive 
      heart failure. Acute induction of atrial fibrillation with rapid atrial pacing 
      demonstrated that the associated ventricular rate could be satisfactorily slowed 
      with digitalis therapy. Initially, short bursts from an implanted, radiofrequency 
      controlled, patient activated pacemaker programmed to a rate of 600 bpm and 
      connected to a permanent endocardial atrial J lead successfully interrupted the 
      tachycardia and precipitated atrial fibrillation. Over a period of 3 months, this 
      therapy changed the patient's heart failure to NYHA class II status. 
      Subsequently, precipitation of atrial fibrillation with this technique failed, 
      resulting in return to NYHA class III-IV congestive heart failure. Therefore, a 
      custom-designed, high rate, rate-programmable pacemaker was implanted to pace the 
      atria rapidly and continuously to maintain atrial fibrillation. A pacing rate of 
      375 bpm plus digoxin slowed the ventricular rate to 70-80 bpm, with stabilization 
      of the congestive heart failure to NYHA class II. The pacemaker generator was 
      replaced 6 months later, and after another 5 months, pacing was discontinued. The 
      patient's subsequent rhythm remained stable atrial fibrillation with clinically 
      successful control of both the ventricular rate and heart failure (NYHA class II) 
      until the patient's death 72 months later. This unique case demonstrates another 
      form of chronic therapy which, in selected cases, can be used for the long term 
      control of rapid ventricular response rates to supraventricular arrhythmia.
FAU - Moreira, D A
AU  - Moreira DA
AD  - Department of Medicine, Case Western Reserve University, Cleveland, Ohio.
FAU - Shepard, R B
AU  - Shepard RB
FAU - Waldo, A L
AU  - Waldo AL
LA  - eng
GR  - R01 HL 38408/HL/NHLBI NIH HHS/United States
PT  - Case Reports
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - Pacing Clin Electrophysiol
JT  - Pacing and clinical electrophysiology : PACE
JID - 7803944
RN  - 0 (Anti-Arrhythmia Agents)
SB  - IM
MH  - Anti-Arrhythmia Agents/therapeutic use
MH  - *Atrial Fibrillation
MH  - Cardiac Pacing, Artificial/*methods
MH  - Cardiomyopathy, Dilated/etiology/*therapy
MH  - Electrocardiography
MH  - Equipment Design
MH  - Female
MH  - Humans
MH  - Middle Aged
MH  - *Pacemaker, Artificial
MH  - Tachycardia, Supraventricular/complications/*therapy
EDAT- 1989/05/01 00:00
MHDA- 1989/05/01 00:01
CRDT- 1989/05/01 00:00
PHST- 1989/05/01 00:00 [pubmed]
PHST- 1989/05/01 00:01 [medline]
PHST- 1989/05/01 00:00 [entrez]
AID - 10.1111/j.1540-8159.1989.tb01898.x [doi]
PST - ppublish
SO  - Pacing Clin Electrophysiol. 1989 May;12(5):761-75. doi: 
      10.1111/j.1540-8159.1989.tb01898.x.