title: Randomized crossover comparison of DDDR versus VDD pacing after atrioventricular junction ablation for prevention of atrial fibrillation. The atrial pacing peri-ablation for paroxysmal atrial fibrillation (PA (3)) study investigators.
abstract: BACKGROUND
  Some clinical data suggest that atrial-based pacing prevents paroxysmal atrial fibrillation (AF). This study tested the hypothesis that DDDR pacing compared with VDD pacing prevents AF after atrioventricular (AV) junction ablation.
  
  
  RESULTS
  Patients were randomized to DDDR pacing (n=33) or to VDD pacing (n=34) after AV junction ablation and followed every 2 months for 6 months. Patients then crossed over to the alternate pacing mode and were followed for an additional 6 months. Primary analysis included the time to first recurrence of sustained AF (duration >5 minutes), total AF burden, and the development of permanent AF. The time to first episode of AF was similar in the DDDR group (0.37 days, 95% CI 0.1 to 1.3 days) and the VDD pacing group (0.5 days, 95% CI 0.2 to 1.7 days, P=NS). AF burden increased over time in both groups (P<0.01). At the 6-month follow-up, AF burden was 6.93 h/d (95% CI 4. 37 to 10.96 h/d) in the DDDR group and 6.30 h/d (95% CI 3.99 to 9.94 h/d) in the VDD group (P=NS). Twelve (35%) patients in the DDDR group and 11 (32%) patients in the VDD group had permanent AF within 6 months of ablation. Within 1 year of follow-up, 43% of patients had permanent AF.
  
  
  CONCLUSIONS
  DDDR pacing compared with VDD pacing does not prevent paroxysmal AF over the long term in patients in the absence of antiarrhythmic drug therapy after total AV junction ablation. Many patients have permanent AF within the first year after ablation.
authors.affiliation: Division of Cardiology, Foothills Hospital and the University of Calgary, Calgary, Alberta, Canada.
authors.forename: A M
authors.initials: AM
authors.lastname: Gillis
authors.forename: S J
authors.initials: SJ
authors.lastname: Connolly
authors.forename: P
authors.initials: P
authors.lastname: Lacombe
authors.forename: F
authors.initials: F
authors.lastname: Philippon
authors.forename: M
authors.initials: M
authors.lastname: Dubuc
authors.forename: C R
authors.initials: CR
authors.lastname: Kerr
authors.forename: R
authors.initials: R
authors.lastname: Yee
authors.forename: M S
authors.initials: MS
authors.lastname: Rose
authors.forename: D
authors.initials: D
authors.lastname: Newman
authors.forename: K M
authors.initials: KM
authors.lastname: Kavanagh
authors.forename: M J
authors.initials: MJ
authors.lastname: Gardner
authors.forename: T
authors.initials: T
authors.lastname: Kus
authors.forename: D G
authors.initials: DG
authors.lastname: Wyse
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000517:prevention & control* / Q000601:surgery / Q000628:therapy*; D001283:Atrioventricular Node / Q000601:surgery*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D012008:Recurrence; D016019:Survival Analysis; D013997:Time Factors