Luigi Padeletti1, Helmut Pürerfellner2, Lluis Mont3, Raymond Tukkie4, Antonis S Manolis5, Renato Ricci6, Giuseppe Inama7, Paolo Serra8, Mike G Scheffer9, Vitor Martins10, Eduardo N Warman11, Marco Vimercati12, Andrea Grammatico13, Giuseppe Boriani14. 1. Institute of Internal Medicine and Cardiology, University of Florence, Florence, Italy. 2. Akademisches Lehrkrankenhaus der Elisabethinen, Linz, Austria. 3. Department of Cardiology, Hospital Clinic, University of Barcelona, Barcelona, Spain. 4. Kennemer Gasthuis, Haarlem, The Netherlands. 5. Third Department of Cardiology, Athens University School of Medicine, Athens, Greece. 6. Cardiology Department, S. Filippo Neri Hospital, Rome, Italy. 7. Institute of Cardiology, Maggiore Hospital, Crema, Italy. 8. Cardiology Department, G. Mazzini Hospital, Teramo, Italy. 9. Department of Cardiology, Maasstad Ziekenhuis, Rotterdam, The Netherlands. 10. Hospital Distrital de Santarém, Santarém, Portugal. 11. Medtronic Inc., Minneapolis, Minnesota. 12. Medtronic Clinical Operations, Milan, Italy. 13. Medtronic EMEA Regional Clinical Centre, Rome, Italy. 14. Institute of Cardiology, S. Orsola-Malpighi University Hospital, Bologna, Italy. Electronic address: giuseppe.boriani@unibo.it.
Abstract
BACKGROUND: Atrial fibrillation (AF) is a frequent comorbidity in patients with pacemaker and is a recognized cause of mortality, morbidity, and quality-of-life impairment. The international MINimizE Right Ventricular pacing to prevent Atrial fibrillation and heart failure trial established that atrial preventive pacing and atrial antitachycardia pacing (DDDRP) in combination with managed ventricular pacing (MVP) reduce permanent AF occurrence in comparison with standard dual-chamber pacing (DDDR). OBJECTIVE: We aimed to determine the role of new-generation atrial antitachycardia pacing (Reactive ATP) in preventing AF disease progression. METHODS:Patients with dual-chamber pacemaker and with previous atrial tachyarrhythmias were randomly assigned to DDDR (n = 385 (33%)), MVP (n = 398 (34%)), or DDDRP+MVP (n = 383 (33%)) group. The incidence of permanent AF, as defined by the study investigator, or persistent AF, defined as ≥7 consecutive days with AF, was estimated using the Kaplan-Meier method, while its association with patients' characteristics was evaluated via multivariable Cox regression. RESULTS: At 2 years, the incidence of permanent or persistent AF was 26% (95% confidence interval [CI] 22%-31%) in the DDDR group, 25% (95% CI 21%-30%) in the MVP group, and 15% (95% CI 12%-20%) in the DDDRP+MVP group (P < .001 vs. DDDR; P = .002 vs. MVP). Generalized estimating equation-adjusted Reactive ATP efficacy was 44.4% (95% CI 41.3%-47.6%). Multivariate modeling identified high Reactive ATP efficacy (>44.4%) as a significant predictor of reduced permanent or persistent AF risk (hazard ratio 0.32; 95% CI 0.13-0.781; P = .012) and episodes' characteristics, such as long atrial arrhythmia cycle length, regularity, and the number of rhythm transitions, as predictors of high ATP efficacy. CONCLUSION: In patients with bradycardia, DDDRP+MVP delays AF disease progression, with Reactive ATP efficacy being an independent predictor of permanent or persistent AF reduction.
RCT Entities:
BACKGROUND:Atrial fibrillation (AF) is a frequent comorbidity in patients with pacemaker and is a recognized cause of mortality, morbidity, and quality-of-life impairment. The international MINimizE Right Ventricular pacing to prevent Atrial fibrillation and heart failure trial established that atrial preventive pacing and atrial antitachycardia pacing (DDDRP) in combination with managed ventricular pacing (MVP) reduce permanent AF occurrence in comparison with standard dual-chamber pacing (DDDR). OBJECTIVE: We aimed to determine the role of new-generation atrial antitachycardia pacing (Reactive ATP) in preventing AF disease progression. METHODS:Patients with dual-chamber pacemaker and with previous atrial tachyarrhythmias were randomly assigned to DDDR (n = 385 (33%)), MVP (n = 398 (34%)), or DDDRP+MVP (n = 383 (33%)) group. The incidence of permanent AF, as defined by the study investigator, or persistent AF, defined as ≥7 consecutive days with AF, was estimated using the Kaplan-Meier method, while its association with patients' characteristics was evaluated via multivariable Cox regression. RESULTS: At 2 years, the incidence of permanent or persistent AF was 26% (95% confidence interval [CI] 22%-31%) in the DDDR group, 25% (95% CI 21%-30%) in the MVP group, and 15% (95% CI 12%-20%) in the DDDRP+MVP group (P < .001 vs. DDDR; P = .002 vs. MVP). Generalized estimating equation-adjusted Reactive ATP efficacy was 44.4% (95% CI 41.3%-47.6%). Multivariate modeling identified high Reactive ATP efficacy (>44.4%) as a significant predictor of reduced permanent or persistent AF risk (hazard ratio 0.32; 95% CI 0.13-0.781; P = .012) and episodes' characteristics, such as long atrial arrhythmia cycle length, regularity, and the number of rhythm transitions, as predictors of high ATP efficacy. CONCLUSION: In patients with bradycardia, DDDRP+MVP delays AF disease progression, with Reactive ATP efficacy being an independent predictor of permanent or persistent AF reduction.
Authors: George H Crossley; Luigi Padeletti; Steven Zweibel; J Harrison Hudnall; Yan Zhang; Giuseppe Boriani Journal: Pacing Clin Electrophysiol Date: 2019-04-29 Impact factor: 1.976
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