[Treatment of supraventricular arrhythmia by permanent cardiac pacing]

Most pacemakers are used for the treatment of bradyarrhythmias. However, a small number of pacemakers has been implanted for the treatment of supraventricular tachycardia resistant to medical therapy. The results of small reported series show long-term pacing to be effective in terminating reentrant atrial and junctional tachycardia. This has led to an improved quality of life and fewer hospital admissions in the majority of patients. Although there are a number of limitations to the widespread use of this mode of treatment, the development of pacing techniques has improved our understanding of the mechanism of termination of tachycardia which has been fully used in ventricular tachyarrhythmias. In addition to the curative treatment of sustained junctional tachycardia, pacemakers have been implanted to prevent the occurrence of new episodes with seemingly equally satisfactory results. However, cardiac pacing for this indication is much less common now because of the very good results obtained recently by radiofrequency ablation techniques. The prevention of atrial arrhythmias, vagally-induced atrial tachyarrhythmias and the bradycardia-tachycardia syndrome are good indications for permanent pacing. The prevention of atrial fibrillation in sinus node dysfunction by pacing is becoming more popular with the emergence of new modes (DDI and rate-adjusted modes) and original arrhythmia preventing algorithms. The discussion about the real efficacy of atrial pacing in sinus node dysfunction is disappearing as results of prospective randomised trials confirming this efficacy become available, especially in preventing atrial fibrillation.