For anti-tachycardia pacing, what rates (beats/min) or cycle lengths (CL, msec) are effective for cardioversion of supraventricular tachycardia (SVT) or atrial flutter?
(Note: CL = 60,000/pacing rate.) In 13 pediatric patients, Butto et al cardioverted 48 of 51 flutter episodes to sinus or junctional rhythm using TAP with a CL of 50-100 msec less than the flutter CL; 10/48 episodes transiently converted to atrial fibrillation lasting 3 sec to 28 minutes before spontaneous conversion to sinus junctional rhythm. For overdrive suppression of atrial flutter in children, Campbell et al compared esophageal and intracardiac rapid atrial pacing using a CL fixed at 72% of the flutter CL, with success rates of 73% and 63%, respectively. In 49 patients with atrial flutter, Kantharia et al applied TAP at a rate set at 41% higher than the flutter rate and achieved immediate sinus rhythm (35%), delayed sinus rhythm (27%), atrial fibrillation (22%), for an overall successful conversion rate of 84%. In a literature review, Jadvar & Arzbaecher found atrial pacing with a CL of 72% to 78% of the atrial tachycardia CL to be effective at terminating SVT. The authors recom
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