title: Relationship between selected overdrive parameters and the therapeutic outcome and tolerance of atrial overdrive pacing.
abstract: There is a paucity of information on the influence of selected overdrive parameters on the clinical efficacy and tolerance of atrial overdrive algorithms to suppress atrial tachyarrhythmias. Data from a completed clinical trial investigating a new DDD+ overdrive algorithm implemented in a permanent pacemaker were analyzed. One-hundred patients with standard pacing indications and atrial tachyarrhythmias were enrolled and followed for 6 months in DDD and 6 months in DDD+ mode in a randomized, crossover fashion. The overdrive step size was programmed at the discretion of the investigators between 4 and 12 beats/min, overdrive plateau length between 10 and 32 beats, and maximum overdrive rate between 100 and 160 beats/min. The effects of DDD+ versus DDD mode on burden and incidence of atrial tachyarrhythmias stored in the mode switch memory were examined as a function of the programmed overdrive parameters. An overdrive step size between 7 and 12 beats/min, and higher a maximum overdrive rate between 121 and 160 beats/min were slightly more effective than lower programmed values, though > 500 randomized, crossover observations would have been necessary to verify statistical significance. Overdrive pacing related symptoms mandated early manual deactivation of overdrive pacing in 4.7% of 85 evaluated patients. Overdrive was disabled without testing tolerability of less aggressive overdrive values. There was no link between patient symptoms and programmed overdrive step size or overdrive plateau length values.
authors.affiliation: Center Médico-chirurgical Parly 2, 21 rue Moxouris, F-78150 Le Chesnay, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Attuel
authors.forename: Dejan
authors.initials: D
authors.lastname: Danilovic
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Konz
authors.forename: Johannes
authors.initials: J
authors.lastname: Brachmann
authors.forename: Dia
authors.initials: D
authors.lastname: el Allaf
authors.forename: Steffen
authors.initials: S
authors.lastname: Löscher
authors.forename: Candido
authors.initials: C
authors.lastname: Gomes
authors.forename: Thomas
authors.initials: T
authors.lastname: Scheibner
authors.forename: Volker
authors.initials: V
authors.lastname: Schibgilla
authors.forename: Istvan
authors.initials: I
authors.lastname: Szendey
authors.forename: Andreas
authors.initials: A
authors.lastname: Hartmann
mesh_terms: D000368:Aged; D000465:Algorithms; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000379:methods*; D018592:Cross-Over Studies; D006325:Heart Atria; D006339:Heart Rate; D006801:Humans; D013610:Tachycardia / Q000503:physiopathology / Q000628:therapy*