Prevention of long-lasting atrial fibrillation through antitachycardia pacing in 584 dual-chamber pacemaker patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Boriani ◽  
Y Sakamoto ◽  
S Iacopino ◽  
S Komura ◽  
P Pieragnoli ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Poor Quality ◽  
World Population ◽  
Atrial Pacing ◽  
Dual Chamber ◽  
Antitachycardia Pacing ◽  
Dual Chamber Pacemaker ◽  
Randomized Evaluation ◽  
Low Incidence ◽  
Preventive Atrial Pacing

Abstract Background Atrial fibrillation (AF) is a frequent arrhythmia in pacemaker patients and is associated with poor quality of life and increased risks of heart failure, dementia, stroke, and death. The MINERVA trial has shown that the combination of 3 pacing algorithms – 1) atrial antitachycardia pacing (aATP), 2) atrial preventive pacing and 3) managed ventricular pacing (MVP) - delays progression to persistent and permanent AF, compared with standard DDDR pacing mode and with MVP mode, in pacemaker patients with AF history. Purpose We performed a comparative non randomized evaluation to confirm the hypothesis that aATP is the main driver of persistent/permanent AF reduction independently on the effect of preventive atrial pacing. Methods Thirty-one Italian and Japanese Cardiology centers included consecutive dual-chamber pacemaker patients with AF history. aATP was programmed in all patients while preventive atrial pacing was not enabled. Comparison was made with all the 3 groups in MINERVA randomized trial. The main endpoint was incidence of AF longer than 7 consecutive days, as detected by device diagnostics. Results A total of 146 patients (73 years old, 54% male) were included and followed for a median observation period of 31 months. The 2-year incidence of AF>7 days was 12% in the aATP group, very similar to that found in the arm of the MINERVA trial with aATP enabled (13.8%, p=0.732) and significantly lower than AF incidence found in the MINERVA Control DDDR arm (25.8%, p=0.012) and in the MINERVA MVP arm (25.9%, p=0.025). Conclusions In a real-world population of dual-chamber pacemaker patients with AF history, use of aATP was associated with low incidence of persistent AF during follow up, highlighting that the positive results of the MINERVA trial are related to the effectiveness of aATP rather than to the effects of preventive atrial pacing. Funding Acknowledgement Type of funding source: None

Increased base rate of atrial pacing for prevention of atrial fibrillation after implantation of a dual-chamber pacemaker: insights from the Atrial Overdrive Pacing Study

EP Europace ◽  
2007 ◽  
Vol 9 (11) ◽  
pp. 1024-1030 ◽  
Author(s):  
B. K. Kantharia ◽  
R. A. Freedman ◽  
D. Hoekenga ◽  
G. Tomassoni ◽  
S. Worley ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Base Rate ◽  
Atrial Pacing ◽  
Dual Chamber ◽  
Dual Chamber Pacemaker ◽  
Overdrive Pacing

scholarly journals Dual chamber pacemaker in the treatment of paroxysmal atrial fibrillation

2005 ◽  
Vol 62 (4) ◽  
pp. 329-334
Author(s):  
Goran Radjen ◽  
Sasa Rafajlovski ◽  
Zoran Perisic ◽  
Radoslav Romanovic
Keyword(s):  
Atrial Fibrillation ◽  
Paroxysmal Atrial Fibrillation ◽  
Antiarrhythmic Drugs ◽  
Atrial Pacing ◽  
Cardiac Dysrhythmia ◽  
Dual Chamber ◽  
Short Term ◽  
Dual Chamber Pacemaker ◽  
Symptomatic Bradycardia ◽  
High Level

Background. Atrial fibrillation is the most frequent cardiac dysrhythmia. The aim of this study was to show the role and the efficacy of a dual chamber pacemaker with the algorithm of atrial dynamic overdrive, in the suppression of paroxysmal atrial fibrillation. Case report. A woman with a classical bradycardia-tachycardia syndrome, and frequent attacks of atrial fibrillation, underwent the implantation of a single chamber permanent pacemaker (VVI). Pacemaker successfully treated the episodes of symptomatic bradycardia, but the patient had frequent attacks of atrial fibrillation, despite the use of different antiarrhythmic drugs, which she did not tolerate well. The decision was made to reimplant a permanent dual chamber pacemaker with the algorithm of atrial dynamic overdrive. The pacemaker was programmed to the basic rate of 75/min, while rate at rest was 55/min. In addition, sotalol was administered. After three months, the patient became asymptomatic with only 4 short ? term episodes of atrial fibrillation, and a high level of atrial pacing (99%). Conclusion. In selected patients with bradycardia?tachycardia syndrome, atrial-based pacing seemed to be very effective in reducing the incidence of paroxysmal atrial fibrillation.

P6556Prevention of long-lasting atrial fibrillation through device therapy in dual-chamber pacemakers: analysis on 1384 patients of the role of Reactive ATP and atrial preventive pacing

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Boriani ◽  
P Pieragnoli ◽  
G L Botto ◽  
M Gulizia ◽  
M Landolina ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Sinus Node ◽  
Atrial Pacing ◽  
Dual Chamber ◽  
Dual Chamber Pacemaker ◽  
Pacing Mode ◽  
Node Disease ◽  
Dual Chamber Pacemakers ◽  
Observation Period ◽  
Preventive Atrial Pacing

Abstract Background Atrial fibrillation (AF) is the most prevalent heart rhythm disorder in clinical practice and it is associated with poor quality of life and increased risks of heart failure, dementia, stroke, and death. Moreover AF management is a huge cost for healthcare systems. AF is irregular, typically originates from the pulmonary veins, and as such, requires cardioversion to terminate persistent episodes. AF is not susceptible to pace-termination, however, the MINERVA trial has shown that AF may transform in slower organized rhythms such as atrial flutter or atrial tachycardia, which can often be terminated by atrial anticahycardia pacing (ATP); in particular by Reactive ATP, a specific ATP feature which can be re-armed when atrial arrhythmias get slower or more regular. The MINERVA trial showed that the combination of ATP, preventive atrial pacing algorithms and minimal ventricular pacing (MVP) was associated with lower progression to persistent and permanent AF, compared with standard DDD pacing mode and to MVP mode, in pacemaker patients with clinical history of AF. Purpose We aimed to confirm MINERVA trial results in real-world clinical practice and to evaluate whether AF prevention was associated with preventive atrial pacing or solely with ATP. Indeed in our project atrial preventive pacing algorithms were not enabled and the pacing mode (DDD or MVP) was chosen according to patients' AV conduction characteristics. Methods Consecutive dual-chamber pacemaker patients with sinus node disease and device detected AT/AF were prospectively followed by 30 Italian cardiologic centers in an observational research. Clinical and device data were collected and reviewed by expert cardiologists to assess AT/AF occurrence through in clinic visit and/or remote transmissions of device data. Results A total of 239 patients (73 years old, 56% male) wearing a dual-chamber pacemaker with Reactive ATP were included in the project, followed for a median observation period of 13 months and compared with 1145 patients included in the MINERVA trial followed for a median observation period of 34 months and programmed with DDD pacing mode (383 patients), MVP (389 patients) and MVP+Reactive ATP+preventive algorithms (373 patients). As shown in the following figure incidence of 7 consecutive days of AF in the patients treated by DDD/MVP+Reactive ATP in real-world clinical practice was very similar to that found in the MINERVA trial arm programmed with MVP+Reactive ATP+preventive algorithms. Incidence of AF longer than 7 days Conclusions Our analysis performed in a population of sinus node disease patients with dual-chamber pacemakers confirmed MINERVA trial results in terms of prevention of long-lasting AF episodes. In particular these results confirm the benefit associated with the use of Reactive ATP, rather than preventive atrial pacing algorithms.

scholarly journals Sinus node dysfunction associates with atrial high-rate episodes after DDD pacemaker implantation

2019 ◽  
Author(s):  
Qi Xue ◽  
Hai Zou ◽  
Lihong Wang ◽  
Hong Shao ◽  
Yuan Ma
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Node ◽  
Pacemaker Implantation ◽  
Structural Heart Disease ◽  
Sinus Node Dysfunction ◽  
High Rate ◽  
Atrial Pacing ◽  
Dual Chamber ◽  
Dual Chamber Pacemaker ◽  
Increased Risk

Abstract Background： Patients implanted with pacemakers frequently develop atrial fibrillation. Pacemaker-detected atrial high-rate episodes or AHREs, where one AHRE is defined as ≥ 160beats/min lasting ≥ 5 minutes, may identify patients at increased risk for stroke and death. In this study, we sought to observe whether patients with sinus node dysfunction or atria-ventricular block are more likely to develop AHREs. Methods: A total of 103 patients (age 69.4±13.5 years，58% female) with DDD/DDDR pacemakers were enrolled for the study. These pacemakers were equipped with features that enabled the detection and storage of information such as the dates, durations and sequential episodes of AHRE. Patients were followed up for 2 years and the time of the first occurrence of AHRE was determined at follow-up visit. Other data such as age, gender, structural heart disease, concomitant non-cardiac diseases, the cumulative percentage of atrial pacing (Cum% AP) and ventricular pacing (Cum% VP) were also collected. Results: Atrial fibrillation developed frequently after the dual-chamber pacemaker implantation. AHRE occurred more often in patients with sinus node disease (SND) than those with atrioventricular block (AVB) （OR, 2.553; 95%CI, 1.122-5.814；P=0.045）. Conclusions: AHRE developed frequently after dual-chamber pacemaker implantation. Patients with SND are more likely to develop AF compared to the patients with AVB.

scholarly journals Epicardial Unipolar Lead Loss of Ventricular Capture during Radiofrequency Ablation of Atrial Fibrillation

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Daniel J. Chu ◽  
Wilson W. Lam
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Pulmonary Vein ◽  
Case History ◽  
Pulse Generator ◽  
Persistent Atrial Fibrillation ◽  
Dual Chamber ◽  
Dual Chamber Pacemaker ◽  
Cellular Changes ◽  
Unipolar Lead

Introduction. Abnormal pacemaker behavior can occur during radiofrequency ablation. The behaviors are varied and include loss of capture. The mechanisms in this context have not been well described in the literature. We describe a case of epicardial unipolar lead loss of ventricular capture during pulmonary vein isolation. Case History. A 48-year-old man with an epicardial dual chamber pacemaker and persistent atrial fibrillation presented for radiofrequency ablation (RFA) of his abnormal rhythm. During RFA, intermittent loss of ventricular capture was witnessed. Review of the device settings prior to and after the procedure showed an increase in ventricular threshold after the procedure. Loss of capture was shown to be dependent on location and RF energy delivered. It was independent of QTc and independent of local cellular changes that would increase threshold. Conclusion. We hypothesize the mechanism of loss of ventricular capture in this patient with an epicardial pacemaker with unipolar leads is related to intermittent shunt of voltage from the pulse generator to the grounding pad rather than the unipolar lead.

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