Predictors of atrial antitachycardia pacing efficacy in patients affected by brady-tachy form of sick sinus syndrome and implanted with a DDDRP device.
Predictors of ATP efficacy in brady/tachy patients.


BACKGROUND
Recent options to treat atrial tachyarrhythmias (ATA) include implantable devices delivering antitachycardia pacing therapies (ATP). No prospective study selected patients with higher chances of episode termination by ATP or indicated the most effective ATP use. Our aim was to study ATP efficacy in patients with brady-tachy form of sinus node disease (SND), identifying clinical factors, ATA characteristics, and device features predicting ATP efficacy.


RESULTS
Three hundred and sixteen patients (105 M, aged 71.1+/-8.8 years) received a DDDRP pacemaker and were prospectively followed. Median follow-up was 18 months: 37,125 ATA episodes occurred in 217 patients; ATP treated 5,536 of them. Overall, ATP efficacy was 50.0%. A multivariate analysis identified longer arrhythmia cycle lengths (OR=1.25; CI=1.07-1.47) and shorter delays to ATP delivery (OR=0.15; CI=0.10-0.22) as independent predictors of ATP efficacy for episodes preceded by >or=5 minutes of sinus rhythm. Additionally, ATP efficacy for all treated episodes was predicted by lower New York Heart Association (NYHA) class (OR=0.64; CI=0.42-0.98), episode classification as nonimmediate recurrence of ATA (non-IRAT) (OR=0.07; CI=0.02-0.33), absence of overlap in the device detection windows (OR=0.54; CI=0.32-0.91), and flecainide treatment (OR=2.22; CI=1.04-4.71).


CONCLUSIONS
In patients paced for SND, multivariate analysis shows that ATP efficacy is associated to longer arrhythmia cycle lengths, shorter ATP delivery delays, NYHA class I, episode classification as non-IRAT, absence of overlap in the atrial arrhythmia device detection windows, and flecainide treatment.
Boriani
Giuseppe
G
Institute of Cardiology, University of Bologna and Azienda Ospedaliera, S.Orsola-Malpighi, Bologna, Italy. cardio1@med.unibo.it
Padeletti
Luigi
L
Santini
Massimo
M
Gulizia
Michele
M
Capucci
Alessandro
A
Botto
Gianluca
G
Ricci
Renato
R
Molon
Giulio
G
Accogli
Michele
M
Vicentini
Alfredo
A
Biffi
Mauro
M
Vimercati
Marco
M
Grammatico
Andrea
A
D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D015331:Cohort Studies; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D010138:Pacemaker, Artificial; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012804:Sick Sinus Syndrome / Q000503:physiopathology* / Q000628:therapy*; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents