creators_name: Levine, Paul A. creators_name: Wachsner, Robin creators_name: El-Bialy, Adel editors_name: Singh, Balbir editors_name: Lokhandwala, Yash editors_name: Francis, Johnson editors_name: Gupta, Anup type: journalp datestamp: 2005-05-02 lastmod: 2011-03-11 08:56:01 metadata_visibility: show title: Pacing for the Suppression of Paroxysmal Atrial Fibrillation in an 87-year-old Patient ispublished: pub subjects: ipej full_text_status: public keywords: Atrial Fibrillation; Pacing abstract: Background: Sinus node dysfunction, atrioventricular (AV) block and atrial fibrillation (AF) are associated with advanced age. Required therapy commonly includes pacemaker implantation. Methods: We report the course of therapy for an 87-year-old with symptomatic sinus node dysfunction and paroxysmal atrial fibrillation who was intolerant of drug therapy. Results: The patient received a pacemaker for treatment of sick sinus syndrome. She continued to have symptomatic episodes of AF and was intolerant of pharmacologic therapy despite adequate rate support provided by the pacemaker. The AF suppression algorithm in the pacemaker was enabled, resulting in the elimination all AF episodes effectively eliminating the need for antiarrhythmic medication. If this continues to stabilize her atrium, withdrawal of anticoagulation therapy is anticipated. Conclusions: The clinical presentation of sinus node dysfunction and related conduction abnormalities is common in the elderly. Pharmacologic management is often a challenge in the presence of the advanced age and concomitant disease processes. In individuals who have paroxysmal atrial fibrillation or are likely to develop this and who need a pacemaker for standard indications, the availability of an AF Suppression™ algorithm may facilitate their management without needed to use medications or being able to utilize lower doses of those medications. date: 2003-04 date_type: published publication: Indian Pacing and Electrophysiology Journal volume: 3 number: 2 publisher: Indian Pacing and Electrophysiology Group pagerange: 88-90 refereed: TRUE referencetext: 1. Kusumoto FM. Phillips R, Goldschlager N. Pacing therapy in the elderly. The American Journal of Geriatric Cardiology 2002;11:305-16.. 2. Rodriguez RD, Schocken DD. Update on sick sinus syndrome, a cardiac disorder of aging. Geriatrics 1990;24:26-30. 3. Lamas GA, Lee K, Sweeney M, et al. The Mode Selection Trial (MOST) in sinus node dysfunction: design, rationale, and baseline characteristics of the first 1000 patients. Am Heart J. 2000;140:541-551. 4. Podrazik PM, Schwartz JB. Cardiovascular pharmacology of aging. Cardiol Clin 1999;17:17-34. 5. Bernstein AD, Parsonnet V. Survey of cardiac pacing and defibrillation in the United States in 1993. Am J Cardiol 1996;78:187-96. 6. Feinberg WM, Blackshear JL, Laupacis A, et al. Prevalence, age distribution and gender of patients with atrial fibrillation. Analysis and implications. Archives of Int Med 1995;155:469. 7. Gage BF, Fihn SD, White RH. Warfarin therapy for an octogenarian who has atrial fibrillation. Ann Intern Med 2001;134:465-74. 8. Aronow W.S. Management of the older person with atrial fibrillation. Journal of Gerontology: Medical Sciences 2002; 57A:M352-M363. 9. Raza AJ, Movahed A. Use of cardiovascular mediations in the elderly. International J of Cardiology 2002;85:203-215. citation: Levine, Paul A. and Wachsner, Robin and El-Bialy, Adel (2003) Pacing for the Suppression of Paroxysmal Atrial Fibrillation in an 87-year-old Patient. [Journal (Paginated)] document_url: http://cogprints.org/4289/1/levine3.htm