A novel approach to the management of symptomatic junctional and ectopic atrial rhythms

Chronic recurrent junctional and ectopic atrial rhythms are a challenge to manage as they are not responsive to pharmacologic therapy and will usually inhibit standard pacemakers. This report presents two patients with junctional and low atrial rhythms who were successfully managed with a recently introduced atrial overdrive suppression algorithm intended for the treatment of paroxysmal atrial fibrillation. In contrast with the standard AAI mode, the AF suppression algorithm paces progressively faster in response to sensed atrial events (or junctional rhythms with retrograde conduction). Maintaining atrial pacing produces a more normal A-V interval with relieve of symptoms.