[Therapeutic value of programmed stimulation in atrial flutter]

The results of 181 therapeutic stimulations in cases of atrial flutter (a-flut) have shown that a-flut is terminated in a wide range by means of programmed stimulation (PS). A sinus rhythm (SR) was achieved in 68% of cases; out of these 21% changed to SR after brief atrial fibrillation (a-fib). Permanent a-fib was induced by means of PS in 32% of cases. In patients with previous coronary artery bypass surgery (ACVB) SR is to be reckoned with most frequently. SR occurs here in 89.5% of cases; in idiopathic a-flut in 71.8% of cases. In four further sub-samples SR must be expected in about two-thirds of cases. With congenital lesions after corrective surgery, as well as with aortic valve lesions without valve replacement, SR was achieved in 66.7% of cases, and in 64.7% of patients with coronary heart disease without previous coronary bypass surgery. SR resulted by means of PS in 64.3% of aortic lesions after a valve operation. In 76.7% of cases of mitral valve lesions with postoperative a-flut the result was permanent a-fib. A-fib appeared in 80% of mitral lesions without heart operation. The influence of a heart operation is minimal, with SR after PS only occurring with more significant frequency in patients after coronary bypass surgery. The result of the stimulation is not influenced by the duration of the postoperative phase. The techniques of stimulation, with the exception of high rate pacing, are of equal value. Even a persistent a-flut can be terminated by means of high rate pacing, with an a-fib thereby resulting more frequently. In cases of spontaneous as well as post-operative a-flut therapeutic stimulation is an effective form of therapy.