Individualized selection of pacing algorithms for the prevention of recurrent atrial fibrillation: Results from the VIP registry.
OBJECTIVE
The VIP registry investigated the efficacy of preventive pacing algorithm selection in reducing atrial fibrillation (AF) burden.


BACKGROUND
There are few data identifying which patients might benefit most from which preventive pacing algorithms.


METHODS
Patients, with at least one documented AF episode and a conventional antibradycardia indication for pacemaker therapy, were enrolled. They received pacemakers with AF diagnostics and four preventive algorithms (Selection and PreventAF series, Vitatron). A 3-month Diagnostic Phase with conventional pacing identified a Substrate Group (>70% of AF episodes with <2 premature atrial contractions [PACs] before AF onset) and a Trigger Group (< or =70% of AF episodes with <2 PACs before AF onset). This was followed by a 3-month Therapeutic Phase where in the Trigger Group algorithms were enabled aimed at avoiding or preventing a PAC and in the Substrate Group continuous atrial overdrive pacing was enabled.


RESULTS
One hundred and twenty-six patients were evaluated. In the Trigger Group (n = 73), there was a statistically significant 28% improvement in AF burden (median AF burden: 2.06 hours/day, Diagnostic Phase vs 1.49 hours/day, Therapy Phase; P = 0.03304 signed-rank test), and reduced PAC activity. There was no significant improvement in AF burden in the Substrate Group (median AF burden: 1.82 hours/day, Diagnostic Phase vs 2.38 hours/day, Therapy Phase; P = 0.12095 signed-rank test), and little change in PAC activity.


CONCLUSIONS
We identified a subgroup of patients for whom the selection of appropriate pacing algorithms, based on individual diagnostic data, translated into a reduced AF burden. Trigger AF patients were more likely responders to preventive pacing algorithms as a result of PAC suppression.
Department of Cardiology, University of Bonn, Bonn, Germany. th.lewalter@uni-bonn.de
Thorsten
T
Lewalter
Alexander
A
Yang
Dietrich
D
Pfeiffer
Jaap
J
Ruiter
Götz
G
Schnitzler
Tilmann
T
Markert
Mogens
M
Asklund
Oliver
O
Przibille
Armin
A
Welz
Bahman
B
Esmailzadeh
Markus
M
Linhart
Berndt
B
Lüderitz
D000368:Aged; D000465:Algorithms; D001281:Atrial Fibrillation / Q000517:prevention & control*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D016896:Treatment Outcome