In patients with paroxysmal AF not controlled by pharmacological therapy, Abl+Pm treatment is highly effective and superior to drug therapy in controlling symptoms and improving quality of life. The discontinuation of drug therapy exposes patients to further recurrences of paroxysmal AF and the risk of developing permanent AF.

Background Pacemakers and theophylline are currently being used to relieve symptoms in patients with sick sinus syndrome (SSS). However, the impact of either therapy on the natural course of the disease is unknown. We conducted a randomized controlled trial to prospectively assess the effects of pacemakers and theophylline in patients with SSS. Methods and Results One hundred seven patients with symptomatic SSS (age, 73±11 years) were randomized to no treatment (control group, n=35), oral theophylline (n=36), or dual-chamber rate-responsive pacemaker therapy (n=36). They were followed for up to 48 months (mean, 19±14 months). During follow-up, the occurrence of syncope was lower in the pacemaker group than in the control group ( P =.02) and tended to be lower than in the theophylline group ( P =.07). Heart failure occurred less often in patients assigned to pacemaker therapy and theophylline than in control patients (both, P =.05), whereas the incidence of sustained paroxysmal tachyarrhythmias, permanent atrial fibrillation, and thromboembolic events did not show any apparent difference among the three groups. Heart rate was higher in the theophylline group than in the control group. Both pacemaker therapy and theophylline improved symptom scores after 3 months of treatment; however, a similar improvement was observed in the control group. Conclusions In patients with symptomatic SSS, therapy with theophylline or dual-chamber pacemaker is associated with a lower incidence of heart failure; pacemaker therapy is also associated with a lower incidence of syncope. The therapeutic benefits of pacemakers and theophylline on symptoms are partly a result of spontaneous improvement of the disease.

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