Atrial pacing, the forgotten pacing mode

Extract

This year (2008) is the 50th anniversary of the first implantation of a ventricular pulse generator. In the early years, ventricular pacing was the only modality available to treat symptomatic patients with atrioventricular (AV) block as well as the sick sinus syndrome (SSS). The idea to pace the atrium in patients with SSS and intact AV conduction was first realised in 1966 by implantation of electrodes in the wall of either atrium by thoracotomy,1 and subsequently by the transvenous route. In 1969, Kastor et al. reported on long-term pervenous atrial pacing in five patients with intact AV conduction; this was for the treatment of refractory ventricular arrhythmias in two patients and marked sinus bradycardia in three, two of whom also had paroxysmal supraventricular arrhythmias.2 The pervenous method was used to avoid a thoracotomy, and atrial pacing was chosen over ventricular pacing to preserve the normal AV contraction sequence. …