Incidence of arrhythmias after atrial or dual-chamber pacemaker implantation

The incidence of sustained atrial, pacemaker-mediated and ventricular rhythm disturbances was studied retrospectively in a consecutive series of 112 patients without a history of preexisting atrial tachyarrhythmias, receiving an atrial or dual-chamber pacemaker. Early atrial fibrillation (during the first week) was recorded twice. Late atrial fibrillation was seen in seven patients, flutter in one, yielding a total incidence of 8.9% for 22 months. There were no significant differences with respect to age, aetiology, electrocardiographic diagnosis, pacing history, or the measured intracardiac P wave between the group with and the group without atrial fibrillation. Treatment with digoxin reverted three patients to sinus rhythm, association of digoxin and amiodarone, six patients. One patient with congestive heart failure remained in atrial fibrillation. Pacemaker-mediated tachycardia was not a major problem. One patient of a subgroup with known ventricular arrhythmia had a non-sustained ventricular tachycardia during programming at follow-up; sustained ventricular tachycardia was not recorded. Reprogramming to VDD, DVI or VVI was done in 6/100 patients. The incidence of atrial fibrillation or flutter in highly selected patients with dual-chamber or atrial pacing is moderately low. It is not possible to identify patients with a high risk for development of atrial fibrillation; when it occurs, it is easily controlled with drugs. DDD pacing seems to be safe in patients with a history of serious ventricular arrhythmias, treated with appropriate drugs.