[Treatment of supraventricular paroxysmal tachycardia and auricular flutter by auricular stimulation]

Although the management of supraventricular tachycardias (SVT) and atrial flutter (AF1) with drugs or cardioversion is usually effective, their use in the high risk patient commonly digitalized, may be dangerous. Since the availability of an alternate therapeutic method is desirable, the usefulness of atrial pacing was evaluated in 31 episodes of tachyarrhythmia in 31 patients with varied heart conditions. The arrhythmia diagnosis and the stimulation were done through a right atrial electrode. In most cases the rate of stimulation was higher than that of the atria (up to 400 stimuli per min). Of 17 cases with SVT (four with preexcitation syndrome), pacing led to sinus rhythm (SR) in all, even though it was transient in two. SR was obtained in six of eleven cases of AF1, through a short lasting atrial fibrillation (AF) in three of them. Four patients with paroxysmal atrial tachycardia with A-V block changed to AF. SR was achieved shortly after termination of the procedure in two of the latter. It is concluded that atrial pacing is a valuable therapeutic method since it is effective, it has very low risk specially in digitalized patients, its does not require anesthesia and because it may be used repeatedly in case of recurrence. The technique of atrial pacing permits, in some cases, the identification of the mechanism responsible for the arrhythmia.