Ľuboš Urban
Rhythm control in selected patients diagnosed with paroxysmal atrial fibrillation (AF) remains a clinically important goal. The role of pacing therapies for maintaining that goal remains unclear, despite considerable study effort. A moderate decrease in the incidence of acute and chronic AF has been seen with atrial pacing compared with ventricular pacing, especially in patients with sinus node dysfunction. Several pacing strategies and alternate atrial pacing sites have been evaluated to treat AF, including biventricular pacing and various prevention pacing therapies designed to suppress known triggers of AF and achieve ventricular rate regularization. Many recent trials have also shown an increase in AF with ventricular pacing. The use of a device with AF prevention algorithms in a patient with a bradycardia indication for pacing is not unreasonable but there is not enough evidence of benefit. There is no indication for use of a device for AF without a conventional indication for pacing.