Effect of atrial antitachycardia pacing treatments in patients with an atrial defibrillator: randomised study comparing subthreshold and nominal pacing outputs.
OBJECTIVE
To assess the true efficacy of antitachycardia pacing on spontaneous persistent atrial fibrillation in patients with an implanted atrial defibrillator, by comparing the effects of nominal pacing treatment with subthreshold pacing treatment.


METHODS
The effects of antitachycardia pacing and burst 50 Hz atrial pacing on spontaneous atrial arrhythmias were evaluated six months after implantation of a Medtronic Jewel AF((R)) atrial defibrillator.


METHODS
Cardiology department in a district general hospital.


METHODS
15 patients with persistent atrial fibrillation.


METHODS
Patients were randomised to either "nominal" output pacing treatment or surface ECG and endocardial electrogram proven subthreshold "sham" pacing treatment for three months, and then crossed over to the alternative treatment for a further three months.


RESULTS
During the nominal output phase, 31 episodes of atrial fibrillation were treated with 53 bursts of 50 Hz pacing, 98 sequences of ramp atrial pacing, and 61 sequences of burst atrial pacing. Atrial fibrillation was not pace terminated during any episode. Thirty one episodes of atrial tachycardia were treated with 19 bursts of 50 Hz atrial pacing, 103 sequences of ramp atrial pacing, and 38 sequences of burst atrial pacing. Termination of atrial tachycardia was observed in 17 episodes. During the "sham" pacing period, no episodes were terminated by any pacing treatment.


CONCLUSIONS
Atrial antitachycardia pacing treatments are ineffective at terminating persistent atrial fibrillation but may be useful in terminating episodes of atrial tachycardia or flutter, thus reducing the burden of arrhythmia.
Mitchell
A R J
AR
Department of Cardiology, Eastbourne General Hospital, Eastbourne, East Sussex, UK. mitcharj@doctors.org.uk
Spurrell
P A R
PA
Cheatle
L
L
Sulke
N
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016019:Survival Analysis; D013610:Tachycardia / Q000628:therapy; D016896:Treatment Outcome