[Biatrial re-synchronization in the treatment of paroxysmal atrial fibrillation. 3- and 4-chamber pacemaker]

The reason for multisite pacing is to correct atrial and ventricular electrical and mechanical asynchrony found in paroxysmal atrial fibrillation (PAF) and dilated cardiomyopathy. We report the first two cases in Mexico treated with biatrial pacing for PAF. The first was treated with a three chamber pacemaker and the other with a four chamber pacemaker. The first patient was a young man with uncontrolled ventricular rate in whom the atrioventricular conduction was modified with radiofrequency energy to control ventricular rate during atrial fibrillation. The second patient was a woman with corrected transposition of the great arteries, left ventricular ejection fraction (LVEF) of 30% and complete heart block. The pacing modalities were DDD for the first patient and DDDR for the second, both with sleep rate and auto mode switching. The atria were paced in right appendage and the left through the coronary sinus. PAF episodes were, found only in the first patient but were decreased in number and duration. The LVEF and functional class improved in the patient with biatrial and ventricular resynchronization. We conclude that biatrial pacing is effective in PAF.