Pharmacotherapy changes following pacemaker implantation in patients with bradycardia-tachycardia syndrome

Expert Opinion on Pharmacotherapy

Volumn 7, Issue 16, 2006, Pages 2203-2213

  Rucinski, Piotr ^a   Rubaj, Andrzej ^a   Kutarski, Andrzej ^a  

^a MEDICAL UNIVERSITY OF LUBLIN   (Poland)

Author keywords

Antiarrhythmic drugs; Antitachycardia pacing; Atrial fibrillation; Bradycardia tachycardia syndrome; Cardiac pacing; Hybrid therapy; Multisite atrial pacing, sinus node disease; Tachycardia bradycardia syndrome

Indexed keywords

CARDIOVASCULAR AGENT;

ARTIFICIAL HEART PACEMAKER; BRADYCARDIA; CLASSIFICATION; HEART PACING; HUMAN; METHODOLOGY; PATHOPHYSIOLOGY; REVIEW; SYNDROME; TACHYCARDIA;

BRADYCARDIA; CARDIAC PACING, ARTIFICIAL; CARDIOVASCULAR AGENTS; HUMANS; PACEMAKER, ARTIFICIAL; SYNDROME; TACHYCARDIA;

EID: 39049177183     PISSN: 14656566     EISSN: None     Source Type: Journal    
DOI: 10.1517/14656566.7.16.2203     Document Type: Review

References (94)

1. SHORT DS: The syndrome of alternating bradycardia and tachycardia. Br. Heart J. (1954) 16(2):208-214.
2. FERRER MI: The sick sinus syndrome. Circulation (1973) 47(3):635-641.
3. BIGGER JT, JR., REIFFEL JA: Sick sinus syndrome. Ann. Rev. Med. (1979) 30:91-118.
4. AGGARWAL RK, RAY SG, CONNELLY DT et al.: Trends in pacemaker mode prescription 1984-1994: a single centre study of 3710 patients. Heart (1996) 75(5):518-521.
5. BERNSTEIN AD, PARSONNET V: Survey of cardiac pacing and defibrillation in the United States in 1993. Am. J. Cardiol. (1996) 78(2):187-196.
6. LAMAS GA, PASHOS CL, NORMAND SL et al.: Permanent pacemaker selection and subsequent survival in elderly Medicare pacemaker recipients. Circulation (1995) 91(4):1063-1069.
7. GREGORATOS G, ABRAMS J, EPSTEIN AE et al.: ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices - summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/NASPE Committee to Update the 1998 Pacemaker Guidelines). J. Am. Coll. Cardiol. (2002) 40(9):1703-1719. •• Task force on practice guidelines for implantation of cardiac pacemakers and antiarrhythmia devices.
8. SAKSENA S, PRAKASH A, HILL M et al.: Prevention of recurrent atrial fibrillation with chronic dual-site right atrial pacing. J. Am. Coll. Cardiol. (1996) 28(3):687-694. • The first study that evaluated safety and efficacy of multisite right atrial pacing for prevention of AF.
9. ATTUEL P, PELLERIN D, MUGICA J et al.: DDD pacing: an effective treatment modality for recurrent atrial arrhythmias. Pacing Clin. Electrophysiol. (1988) 11(11 Pt 2):1647-1654.
10. SAKSENA S, PANTOPOULOS D, PARSONNET V et al.: Usefulness of an implantable antitachycardia pacemaker system for supraventricular or ventricular tachycardia. Am. J. Cardiol. (1986) 58(1):70-74.
11. DREIFUS LS, MICHELSON EL, KAPLINSKY E: Bradyarrhythmias: clinical significance and management. J. Am. Coll. Cardiol. (1983) 1(1):327-338.
12. PODRID PJ: Aggravatiom of arrhythmia by antiarrhythmic drugs. In: Cardiac Arrhythmia. Mechanismas, Diagnosis and Management. Podrid PJ, Kowey PR (Eds), Williams & Wilkins, Baltimore, MD, USA (1995):507-522.
13. YUSUF S, CAMM AJ: Sinus tachyarrhythmias and the specific bradycardiac agents: a marriage made in heaven? J. Cardiovasc. Pharmacol. Ther. (2003) 8(2):89-105.
14. ISRAEL CW, EHRLICH MD, BAROLD SS et al.: Treatment of atrial tachyarrhythmias with pacing and antiarrhythmic drugs. In: Advances in the Treatment of Atrial Tachyarrhythmias: Pacing, Cardioversion, and Defibrillation. Israel CW, Barold SS (Eds), Futura, Armonk, New York, NY, USA (2002):305-323. •• Interesting book chapter about concomitant antiarrhythmic drugs and pacing therapies.
15. REIFFEL J: Maintenance of normal sinus rhythm with antiarrhythmic drugs. In: Atrial Fibrillation. Kowey PR, Naccarelli GV (Eds), Marcel Dekker, New York, NY, USA (2005):195-217.
16. OVSYSHCHER IE, BAROLD SS: Drug induced bradycardia: to pace or not to pace? Pacing Clin. Electrophysiol. (2004) 27(8):1144-1147. •• Interesting viewpoint article on drug-induced bradycardia. (Pubitemid 39120612)
17. STANTON MS, PRYSTOWSKY EN, FINEBERG NS et al.: Arrhythmogenic effects of antiarrhythmic drugs: a study of 506 patients treated for ventricular tachycardia or fibrillation. J. Am. Coll. Cardiol. (1989) 14(1):209-215.
18. ESSEBAG V, HADJIS T, PLATT RW et al.: Amiodarone and the risk of bradyarrhythmia requiring permanent pacemaker in elderly patients with atrial fibrillation and prior myocardial infarction. J. Am. Coll. Cardiol. (2003) 41(2):249-254.
19. ESSEBAG V, HADJIS T, PLATT RW et al.: Effect of amiodarone dose on the risk of permanent pacemaker insertion. Pacing Clin. Electrophysiol. (2004) 27(11):1519-1525.
20. WEINFELD MS, DRAZNER MH, STEVENSON WG et al.: Early outcome of initiating amiodarone for atrial fibrillation in advanced heart failure. J. Heart Lung Transplant. (2000) 19(7):638-643. (Pubitemid 30621675)
21. SWEENEY MO, HELLKAMP AS, ELLENBOGEN KA et al.: Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation (2003) 107(23):2932-2937. • Important study that showed harmful effect of right ventricular pacing on AF. (Pubitemid 36736635)
22. WILKOFF BL, COOK JR, EPSTEIN AE et al.: Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA (2002) 288(24):3115-3123. • Important study that showed the unfavourable effect of right ventricular pacing on mortality. (Pubitemid 36014128)
23. BAROLD SS, BAROLD HS: Optimal cardiac pacing in patients with coronary artery disease. Pacing Clin. Electrophysiol. (1998) 21(2):456-461.
24. GASPARINI M, MANTICA M, GALIMBERTI P et al.: Relief of drug refractory angina by biventricular pacing in heart failure. Pacing Clin. Electrophysiol. (2003) 26(1 Pt 2):181-184.
25. NOWINSKI K, WECKE L, GADLER F et al.: Pacing-induced electrophysiological remodeling in hypertrophic obstructive cardiomyopathy-observations on cardiac memory. Pacing Clin. Electrophysiol. (2005) 28(6):561-567.
26. HONDA T, SHONO H, KOYAMA J et al.: Impact of right atrial-left ventricular dual-chamber permanent pacing in patients with severely symptomatic hypertrophic obstructive cardiomyopathy. Circ. J. (2005) 69(5):536-542. (Pubitemid 40745726)
27. GADLER F, LINDE C, DARPO B: Modification of atrioventricular conduction as adjunct therapy for pacemaker-treated patients with hypertrophic obstructive cardiomyopathy. Eur. Heart J. (1998) 19(1):132-138.
28. ANDERSEN HR, NIELSEN JC, THOMSEN PE et al.: Long-term follow-up of patients from a randomised trial of atrial versus ventricular pacing for sick-sinus syndrome. Lancet (1997) 350(9086):1210-1216. (Pubitemid 127445094)
29. LAMAS GA, LEE KL, SWEENEY MO et al.: Ventricular pacing or dual-chamber pacing for sinus-node dysfunction. N. Engl. J. Med. (2002) 346(24):1854-1862.
30. RUCINSKI P, KUTARSKI A, WDOWIAK L: Impact of atrial fibrillation history on atrioventricular block appearance in patients with sinus node disease and single chamber atrial pacemaker. Cost-benefit consideration. Eur. Heart J. (2004) 24(Suppl.):602.
31. ANDERSEN HR, NIELSEN JC, THOMSEN PE et al.: Atrioventricular conduction during long-term follow-up of patients with sick sinus syndrome. Circulation (1998) 98(13):1315-1321. (Pubitemid 28443396)
32. BRANDT J, ANDERSON H, FAHRAEUS T et al.: Natural history of sinus node disease treated with atrial pacing in 213 patients: implications for selection of stimulation mode. J. Am. Coll. Cardiol. (1992) 20(3):633-639.
33. KRISTENSEN L, NIELSEN JC, PEDERSEN AK et al.: AV block and changes in pacing mode during long-term follow-up of 399 consecutive patients with sick sinus syndrome treated with an AAI/AAIR pacemaker. Pacing Clin. Electrophysiol. (2001) 24(3):358-365.
34. KRISTENSEN L, NIELSEN JC, MORTENSEN PT et al.: Incidence of atrial fibrillation and thromboembolism in a randomised trial of atrial versus dual chamber pacing in 177 patients with sick sinus syndrome. Heart (2004) 90(6):661-666. (Pubitemid 38668543)
35. NIELSEN JC, KRISTENSEN L, ANDERSEN HR et al.: A randomized comparison of atrial and dual-chamber pacing in 177 consecutive patients with sick sinus syndrome: echocardiographic and clinical outcome. J. Am. Coll. Cardiol. (2003) 42(4):614-623.
36. ROSENQVIST M, OBEL IW: Atrial pacing and the risk for AV block: is there a time for change in attitude? Pacing Clin. Electrophysiol. (1989) 12(1 Pt 1):97-101. (Pubitemid 19145856)
37. SUTTON R, KENNY RA: The natural history of sick sinus syndrome. Pacing Clin. Electrophysiol. (1986) 9(6 Pt 2):1110-1114.
38. GILLIS AM, WYSE DG, CONNOLLY SJ et al.: Atrial pacing periablation for prevention of paroxysmal atrial fibrillation. Circulation (1999) 99(19):2553-2558. (Pubitemid 29228286)
39. KNIGHT BP, GERSH BJ, CARLSON MD et al.: Role of permanent pacing to prevent atrial fibrillation: science advisory from the American Heart Association Council on Clinical Cardiology (Subcommittee on Electrocardiography and Arrhythmias) and the Quality of Care and Outcomes Research Interdisciplinary Working Group, in collaboration with the Heart Rhythm Society. Circulation (2005) 111(2):240-243. (Pubitemid 40139737)
40. BLANC JJ, DE RL, MANSOURATI J et al.: Atrial pacing for prevention of atrial fibrillation: assessment of simultaneously implemented algorithms. Europace (2004) 6(5):371-379. (Pubitemid 39117841)
41. ISRAEL CW: Is there a role for pacing in the prevention of atrial tachyarrhythmias? Europace (2004) 6(5):380-383.
42. DELFAUT P, SAKSENA S, PRAKASH A et al.: Long-term outcome of patients with drug-refractory atrial flutter and fibrillation after single- and dual-site right atrial pacing for arrhythmia prevention. J. Am. Coll. Cardiol. (1998) 32(7):1900-1908. • A study where dual-site right atrial pacing influences on pharmacotherapy are described in detail.
43. SAKSENA S, PRAKASH A, ZIEGLER P et al.: Improved suppression of recurrent atrial fibrillation with dual-site right atrial pacing and antiarrhythmic drug therapy. J. Am. Coll. Cardiol. (2002) 40(6):1140-1150. • Important study on hybrid AF therapy.
44. ISRAEL CW, HUGL B, UNTERBERG C et al.: Pace-termination and pacing for prevention of atrial tachyarrhythmias: results from a multicenter study with an implantable device for atrial therapy. J. Cardiovasc. Electrophysiol. (2001) 12(10):1121-1128.
45. LEE MA, WEACHTER R, POLLAK S et al.: The effect of atrial pacing therapies on atrial tachyarrhythmia burden and frequency: results of a randomized trial in patients with bradycardia and atrial tachyarrhythmias. J. Am. Coll. Cardiol. (2003) 41(11):1926-1932.
46. BORIANI G, PADELETTI L, SANTINI M et al.: Predictors of atrial antitachycardia pacing efficacy in patients affected by brady-tachy form of sick sinus syndrome and implanted with a DDDRP device. J. Cardiovasc. Electrophysiol. (2005) 16(7):714-723.
47. GRANT SC, BENNETT DH: Atrial latency in a dual chambered pacing system causing inappropriate sequence of cardiac chamber activation. Pacing Clin. Electrophysiol. (1992) 15(1):116-118.
48. LEVINE PA, LOVE CJ: Pacemaker diagnostics and evaluation of pacing system malfunction. In: Clinical Cardiac Pacing and Defibrillation. Ellenbogen KA, Kay GN, Wilkoff BL (Eds), WB Saunders Company, Philadelphia, PA, USA (2000):827-875.
49. SCHUCHERT A, MEINERTZ T: Acute effects of a class IA antiarrhythmic drug on the ventricular evoked response amplitude in patients with cardiac pacemakers. Cardiology (2000) 94(2):103-105. (Pubitemid 32110329)
50. ALBONI P, RATTO B, CAPPATO R et al.: Clinical effects of oral theophylline in sick sinus syndrome. Am. Heart J. (1991) 122(5):1361-1367.
51. SAITO D, MATSUBARA K, YAMANARI H et al.: Effects of oral theophylline on sick sinus syndrome. J. Am. Coll. Cardiol. (1993) 21(5):1199-1204.
52. AVERY PG, SMALL J, SHAW DB: Xamoterol in sinus node disease. Int. J. Cardiol. (1993) 40(1):45-49.
53. ALBONI P, MENOZZI C, BRIGNOLE M et al.: Effects of permanent pacemaker and oral theophylline in sick sinus syndrome the THEOPACE study: a randomized controlled trial. Circulation (1997) 96(1):260-266. (Pubitemid 27298430)
54. CAWLEY MJ, AL-JAZAIRI AS, STONE EA: Intravenous theophylline - an alternative to temporary pacing in the management of bradycardia secondary to AV nodal block. Ann. Pharmacother. (2001) 35(3):303-307.
55. 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(4):541-551.
56. SAKSENA S, DELFAUT P, PRAKASH A et al.: Multisite electrode pacing for prevention of atrial fibrillation. J. Cardiovasc. Electrophysiol. (1998) 9(8 Suppl.):S155-S162.
57. BOCCADAMO R, DI BN, MAMMUCARI A et al.: Dual site right atrial pacing in the prevention of symptomatic atrial fibrillation refractory to drug therapy and unrelated to sinus bradycardia. J. Interv. Card Electrophysiol. (2002) 6(2):141-147.
58. D'ALLONNES GR, PAVIN D, LECLERCQ C et al.: Long-term effects of biatrial synchronous pacing to prevent drug-refractory atrial tachyarrhythmia: a nine-year experience. J. Cardiovasc. Electrophysiol. (2000) 11(10):1081-1091.
59. COPLEN SE, ANTMAN EM, BERLIN JA et al.: Efficacy and safety of quinidine therapy for maintenance of sinus rhythm after cardioversion. A meta-analysis of randomized control trials. Circulation (1990) 82(4):1106-1116.
60. WYSE DG, WALDO AL, DIMARCO JP et al.: A comparison of rate control and rhythm control in patients with atrial fibrillation. N. Engl. J. Med. (2002) 347(23):1825-1833. • The largest trial comparing rate- versus rhythm-control strategies.
61. AFFIRM FIRST ANTIARRHYTHMIC DRUG SUBSTUDY INVESTIGATORS: Maintenance of sinus rhythm in patients with atrial fibrillation: an AFFIRM substudy of the first antiarrhythmic drug. J. Am. Coll. Cardiol. (2003) 42(1):20-29.
62. JUUL-MOLLER S, EDVARDSSON N, REHNQVIST-AHLBERG N: Sotalol versus quinidine for the maintenance of sinus rhythm after direct current conversion of atrial fibrillation. Circulation (1990) 82(6):1932-1939.
63. GOSSELINK AT, CRIJNS HJ, VAN G et al.: Low-dose amiodarone for maintenance of sinus rhythm after cardioversion of atrial fibrillation or flutter. JAMA (1992) 267(24):3289-3293.
64. FLAKER GC, BLACKSHEAR JL, MCBRIDE R et al.: Antiarrhythmic drug therapy and cardiac mortality in atrial fibrillation. The Stroke Prevention in Atrial Fibrillation Investigators. J. Am. Coll. Cardiol. (1992) 20(3):527-532.
65. RUCINSKI P, KUTARSKI A, SZCZASNY M et al.: Pharmacotherapy profile changes after pacemaker implantation in patients with bradycardia-tachycardia syndrome. Eur. Heart J. (2005) 26(Suppl.1):579.
66. WOLPERT C, HAASE KK, SUSELBECK T et al.: Hybrid therapy for atrial fibrillation. Eur. Heart J. Suppl. (2003) 5(Suppl. H):H51-H55.
67. KROL RB, SAKSENA S, PRAKASH A: New devices and hybrid therapies and new devices for treatment of atrial fibrillation. J. Interv. Card. Electrophysiol. (2000) 4(Suppl. 1):163-169.
68. SAKSENA S, MADAN N: Hybrid therapy of atrial fibrillation: algorithms and outcome. J. Interv. Card. Electrophysiol. (2003) 9(2):235-247. • Important study on hybrid AF therapy.
69. GARRIGUE S, BAROLD SS, CAZEAU S et al.: Prevention of atrial arrhythmias during DDD pacing by atrial overdrive. Pacing Clin. Electrophysiol. (1998) 21(9):1751-1759.
70. PRAKASH A, DELFAUT P, KROL RB et al.: Regional right and left atrial activation patterns during single- and dual-site atrial pacing in patients with atrial fibrillation. Am. J. Cardiol. (1998) 82(10):1197-1204.
71. DAUBERT JC, PAVIN D, JAUVERT G et al.: Intra- and interatrial conduction delay: implications for cardiac pacing. Pacing Clin. Electrophysiol. (2004) 27(4):507-525. • Interesting review article on the intra- and inter-atrial conduction disturbances and their implications for pacing therapy.
72. ABE Y, FUKUNAMI M, YAMADA T et al.: Prediction of transition to chronic atrial fibrillation in patients with paroxysmal atrial fibrillation by signal-averaged electrocardiography: a prospective study. Circulation (1997) 96(8):2612-2616. (Pubitemid 27451353)
73. LAU CP, TSE HF, YU CM et al.: Dual-site atrial pacing for atrial fibrillation in patients without bradycardia. Am. J. Cardiol. (2001) 88(4):371-375.
74. MADAN N, SAKSENA S: Long-term rhythm control of drug-refractory atrial fibrillation with 'hybrid therapy' incorporating dual-site right atrial pacing, antiarrhythmic drugs, and right atrial ablation. Am. J. Cardiol. (2004) 93(5):569-575.
75. LAU CP: Pacing for atrial fibrillation. Heart (2003) 89(1):106-112. (Pubitemid 36044304)
76. SWEENEY MO, HELLKAMP AS, ELLENBOGEN KA et al.: Prospective randomized study of mode switching in a clinical trial of pacemaker therapy for sinus node dysfunction. J. Cardiovasc. Electrophysiol. (2004) 15(2):153-160.
77. GLOTZER TV, HELLKAMP AS, ZIMMERMAN J et al.: Atrial high rate episodes detected by pacemaker diagnostics predict death and stroke: report of the Atrial Diagnostics Ancillary Study of the Mode Selection Trial (MOST). Circulation (2003) 107(12):1614-1619. (Pubitemid 36397330)
78. FLAMMANG D, LOTEANU V, HAMANI D et al.: Brady-tachy syndrome: rapid atrial pacing efficacy in preventing atrial fibrillation recurrence assessed by reliable electrograms: the prefib pilot study. Europace (2005) 7(5):482-489. (Pubitemid 41135792)
79. WILLEMS R, MORCK ML, EXNER DV et al.: Ventricular high-rate episodes in pacemaker diagnostics identify a high-risk subgroup of patients with tachy-brady syndrome. Heart Rhythm (2004) 1(4):414-421. (Pubitemid 39462613)
80. MEHRA R, ZIEGLER P, KOEHLER J: Diagnostic information in implantable devices that pertain to endpoints in atrial fibrillation studies. Heart Rhythm (2004) 1(2 Suppl.):B64-B69, discussion. (Pubitemid 38878120)
81. ISRAEL CW, NEUBAUER H, OLBRICH HG et al.: Incidence of atrial tachyarrhythmias in pacemaker patients: results from the Balanced Evaluation of Atrial Tachyarrhythmias in Stimulated patients (BEATS) study. Pacing Clin. Electrophysiol. (2006) 29(6):582-588.
82. MADAN N, EL-GABRY I, SAKSENA S: Withdrawal or maintenance of warfarin therapy guided by implantable device datalogs in patients with refractory atrial fibrillation: a novel application of device monitoring in recurrent atrial fibrillation. J. Am. Coll. Cardiol. (2005) 45:102A.
83. FUSTER V, RYDEN LE, CANNOM DS et al.: ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation-executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation). Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Eur. Heart J. (2006) 27(16):1979-2030.
84. RAWLES JM, METCALFE MJ, JENNINGS K: Time of occurrence, duration, and ventricular rate of paroxysmal atrial fibrillation: the effect of digoxin. Br. Heart J. (1990) 63(4):225-227.
85. ISRAEL CW, GRONEFELD G, EHRLICH JR et al.: Long-term risk of recurrent atrial fibrillation as documented by an implantable monitoring device: implications for optimal patient care. J. Am. Coll. Cardiol. (2004) 43(1):47-52.
86. LAU CP, JIANG ZY, TANG MO: Efficacy of ventricular rate stabilization by right ventricular pacing during atrial fibrillation. Pacing Clin. Electrophysiol. (1998) 21(3):542-548.
87. GREENHUT SE, FRASER J, STEINHAUS B et al.: Optimized standby rate reduces the ventricular rate variability in pacemaker patients with atrial fibrillation. Pacing Clin. Electrophysiol. (1996) 19(11 Pt 2):1780-1785.
88. HART RG, HALPERIN JL, PEARCE LA et al.: Lessons from the Stroke Prevention in Atrial Fibrillation trials. Ann. Intern. Med. (2003) 138(10):831-838.
89. GILIS AM, PURERFELLNER H, ISRAEL CW et al.: Reducing unnecessary right ventricular pacing with the managed ventricular pacing mode in patients with sinus node disease and AV block. Pacing Clin. Electrophysiol. (2006) 29(7):697-705
90. CHOUDHURY A, VARUGHESE GI, LIP GY: Targeting the renin-angiotensin- aldosterone-system in atrial fibrillation: a shift from electrical to structural therapy? Expert. Opin. Pharmacother. (2005) 6(13):2193-2207.
91. SIU CW, LAU CP, TSE HF: Prevention of atrial fibrillation recurrence by statin therapy in patients with lone atrial fibrillation after successful cardioversion. Am. J. Cardiol. (2003) 92(11):1343-1345.
92. MOZAFFARIAN D, PSATY BM, RIMM EB et al.: Fish intake and risk of incident atrial fibrillation. Circulation (2004) 110(4):368-373. (Pubitemid 38993844)
93. http://www.af-symposium.org/lectures/ing-saksena-skadsberg-woodjohnson. php SAKSENA S, SKADSBERG N: Hybrid therapy as an alternative in refractory atrial fibrillation: when, why and how? ISHNE AF world-wide internet symposium (2005). •• Interesting website with up-to-date opinions of leading researchers in AF.
94. http://www.biotronik.de BIOTRONIK GmbH & Co., Berlin, Germany. BIOTRONIK Home Monitoring Service (2006).