Radiofrequency-triggered pacemakers: uses and limitations. A long-term study.

Seven patients with either recurrent paroxysmal supraventricular tachycardia (five), alternatinng bradycardiatachycardia (one), or ventricular tachycardia (one) underwent insertion of permanent radiofrequency-triggered pacemakers. Follow-up evaluation (36 +/- 24 months, mean +/- SD) revealed that arrhythmias were well controlled in five of seven patients, although three of the five required medication to decrease frequency of arrhythmias. Overdrive pacing was ineffective in one patient with Wolff-Parkinson-White syndrome who had recurrent bouts of atrial fibrillation or atrial flutter. One additional patient with ventricular tachycardia became refractory to overdrive atrial pacing. These studies document the long-term effectiveness of radiofrequency pacemakers in some patients with recurrent refractory arrhythmias. Careful patient selection and electrophysiologic studies are mandatory before implantation of a permanent radiofrequency pacemaker. Physicians must be aware of both the benefits and possible limitations of radiofrequency pacemakers in order to choose between pacemaker versus surgical intervention in patients with cardiac arrhythmias refractory to standard drug therapy.