[Cardiac stimulations for the treatment of supraventricular arrhythmias]

Permanent cardiac stimulation in patients with supraventricular tachycardia is used primary for treatment and prevention of atrial fibrillation (AF). Different strategies of stimulation have been design for this purpose. Among the most important are: preferential standard atrial pacing, multisite atrial pacing or septal atrial pacing and pacing algorithms for prevention or treatment. Multicentric, controlled and randomized studies design to explore this therapies have disappointing and controversial results. Current therapy is focused in the implant of physiological pacemakers (AAI, DDD) rather than VVI pacemakers. Right apical ventricular stimulation has deleterious effects in ventricular function by producing a dissincronous ventricular contraction and increasing the incidence of AF, so ventricular pacing must be avoided in patients with intact atrioventricular conduction.

Permanent cardiac pacing in patients without symptomatic bradycardia should not be used to treat supraventricular tachycardias. Physiologic pacing should be used to reduce the incidence of AF. Effort should be made to allow normal atrioventricular conduction in patients with sick sinus disease and normal atrioventricular conduction.