Module 1
Topic 3
Lesson 11

Safe pacing ranges vs AF induction

Ante Anic
EP lab director

What will you learn?

  • what is safe range for atrial stimulation
  • when can I expect AF induction
  • what to look for and be prepared for

About this scenario

  • 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.