Giuseppe Boriani1, Raymond Tukkie2, Mauro Biffi3, Lluis Mont4, Renato Ricci5, Helmut Pürerfellner6, Giovanni Luca Botto7, Antonis S Manolis8, Maurizio Landolina9, Michele Gulizia10, J Harrison Hudnall11, Lorenza Mangoni12, Andrea Grammatico12, Luigi Padeletti13. 1. Institute of Cardiology, S. Orsola-Malpighi University Hospital, Bologna, Italy; Cardiology Department, University of Modena and Reggio Emilia, Modena, Italy. Electronic address: giuseppe.boriani@unimore.it. 2. Kennemer Gasthuis, Haarlem, The Netherlands. 3. Institute of Cardiology, S. Orsola-Malpighi University Hospital, Bologna, Italy. 4. Department of Cardiology, University Hospital, Barcelona, Spain. 5. Cardiology Department, S. Filippo Neri Hospital, Rome, Italy. 6. Akademisches Lehrkrankenhaus der Elisabethinen, Linz, Austria. 7. Institute of Cardiology, S. Anna Hospital, Como, Italy. 8. Third Department of Cardiology, University School of Medicine, Athens, Greece. 9. Institute of Cardiology, Maggiore Hospital, Crema, Italy. 10. Cardiology Department, Garibaldi Nesima Hospital, Catania, Italy. 11. Clinical Research Department, Medtronic plc., Minneapolis, Minnesota. 12. EMEA Regional Clinical Centre, Medtronic plc., Rome, Italy. 13. Institute of Internal Medicine and Cardiology, University of Florence, Florence, Italy; IRCCS Multimedica, Sesto San Giovanni, Italy.
Abstract
BACKGROUND:Atrial tachycardia (AT) and atrial fibrillation (AF) are common in pacemaker patients and are associated with bad prognoses. OBJECTIVE: The purpose of this study was to evaluate atrial antitachycardia pacing impact on AT/AF-induced atrial remodeling, measured by early recurrence of AT/AF (ERAF) and by change in left atrial diameter (LAD), and to evaluate the impact of AT/AF duration on ERAF incidence. METHODS:Pacemaker patients were randomized to dual-chamber pacing (Control DDDR: 385 patients), managed ventricular pacing (MVP: 398 patients), or atrial antitachycardia pacing plus MVP (DDDRP+MVP: 383 patients). LAD change, estimated by echocardiography, was considered significant if the relative difference between baseline and 24-month measurements was >10%. RESULTS: At median follow-up of 34 months, ERAF incidence was significantly lower in the DDDRP+MVP arm for all AT/AF durations, in particular, ERAF followed AT/AF longer than 3 hours in 53% cases in Control DDDR, in 51% cases in MVP, and in 39% cases in DDDRP+MVP (P <.001 vs other groups). ERAF incidence showed a U-shaped pattern when evaluated as a function of previous AT/AF duration, decreasing for durations from 5 minutes to 12 hours and increasing for longer durations. Among patients with significant LAD change, the proportion of patients with a reduction in LAD was 35% in Control DDDR, 37% in MVP, and 70% in DDDRP+MVP (P <.05 vs other groups). CONCLUSION: Our data suggest that atrial electrical remodeling becomes important after about 12 hours of continuous arrhythmia. Compared to DDDR or MVP, DDDRP+MVP reduces ERAF and favors LAD reduction, suggesting that atrial antitachycardia pacing may reverse electrical and mechanical remodeling.
RCT Entities:
BACKGROUND:Atrial tachycardia (AT) and atrial fibrillation (AF) are common in pacemaker patients and are associated with bad prognoses. OBJECTIVE: The purpose of this study was to evaluate atrial antitachycardia pacing impact on AT/AF-induced atrial remodeling, measured by early recurrence of AT/AF (ERAF) and by change in left atrial diameter (LAD), and to evaluate the impact of AT/AF duration on ERAF incidence. METHODS: Pacemaker patients were randomized to dual-chamber pacing (Control DDDR: 385 patients), managed ventricular pacing (MVP: 398 patients), or atrial antitachycardia pacing plus MVP (DDDRP+MVP: 383 patients). LAD change, estimated by echocardiography, was considered significant if the relative difference between baseline and 24-month measurements was >10%. RESULTS: At median follow-up of 34 months, ERAF incidence was significantly lower in the DDDRP+MVP arm for all AT/AF durations, in particular, ERAF followed AT/AF longer than 3 hours in 53% cases in Control DDDR, in 51% cases in MVP, and in 39% cases in DDDRP+MVP (P <.001 vs other groups). ERAF incidence showed a U-shaped pattern when evaluated as a function of previous AT/AF duration, decreasing for durations from 5 minutes to 12 hours and increasing for longer durations. Among patients with significant LAD change, the proportion of patients with a reduction in LAD was 35% in Control DDDR, 37% in MVP, and 70% in DDDRP+MVP (P <.05 vs other groups). CONCLUSION: Our data suggest that atrial electrical remodeling becomes important after about 12 hours of continuous arrhythmia. Compared to DDDR or MVP, DDDRP+MVP reduces ERAF and favors LAD reduction, suggesting that atrial antitachycardia pacing may reverse electrical and mechanical remodeling.
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