Safe pacing ranges vs AF induction

Acknowledgement

Ante Anic

EP lab director

What will you learn?

In general extra-stimulus pacing is less likely to induce AF and should be used first.
Incremental and constant atrial pacing at CL lower than 250ms has the greatest potential to induce AF so usually it is performed at the end of EP study.
Look for local signal defragmentation as an early warning prior AF induction
Pacing in 270-240 range might be useful for induction of typical flutter, while short bursts of 300ms should be sufficient to trigger ectopic tachycardia.
Inducing AF and need for subsequent cardioversion (and/or sedation) has huge impact on outcome of following manoeuvres and the course of the whole study. Therefore accidental induction should be avoided.
After AF induction you might wait for few minuets and wait for spontaneous conversion or even ask patient to do some Valsalva manoeuvres like holding the breath and pressing.
AF induction is always a possibility during AF study so you and your team must be prepared for that.