Atrial pacing for prevention of atrial fibrillation: assessment of simultaneously implemented algorithms.
OBJECTIVE
Several preliminary studies indicated that right atrial pacing could prevent atrial tachyarrhythmias (ATA). We sought to compare the safety and the efficacy of atrial-based pacing supplemented by dedicated combined algorithms with conventional atrial pacing in the prevention of ATA.


METHODS
Fifty-five patients with a history of recurrent paroxysmal ATA implanted with a dual-chamber pacemaker were studied during two randomized cross-over pacing periods (conventional DDD and DDD with ATA prevention algorithms) of 6 months duration. The primary endpoint was the burden of ATA episodes recorded by the device mode switch algorithm.


RESULTS
The cross-over analysis did not demonstrate any significant difference between the two pacing modes: 254+/-533 h of ATA during the control period versus 238+/-518 h during the ATA prevention period. Analysis of a subgroup of patients found that those with the lower percentage of ventricular pacing benefited from ATA prevention algorithms (120+/-182 h versus 225+/-350 h during the control period; P < 0.04).


CONCLUSIONS
When compared with DDD pacing at 70 bpm, ATA prevention algorithms have not demonstrated significant efficacy. However, a subgroup of patients with preserved native AV conduction (low percentage of ventricular pacing) responded to ATA prevention algorithms.
Cardiology Department, Brest University Hospital, Brest, France.
Jean-Jacques
JJ
Blanc
Luc
L
De Roy
Jacques
J
Mansourati
Yann
Y
Poezevara
Jean-Louis
JL
Marcon
Wolfgang
W
Schoels
Françoise
F
Hidden-Lucet
Claude
C
Barnay
D000368:Aged; D000465:Algorithms; D001919:Bradycardia / Q000628:therapy; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D018592:Cross-Over Studies; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055502:Secondary Prevention; D016037:Single-Blind Method; D013612:Tachycardia, Ectopic Atrial / Q000517:prevention & control*