[Effect of antitachycardia pacemaker on atrial tachyarrhythmia detection, prevention and termination].
OBJECTIVE
The present study retrospectively evaluated the reliability of detecting atrial tachyarrhythmias (ATA), the efficacy of automatic atrial antitachycardia pacing (ATP) and the performance of atrial preventive pacing (APP) algorithms in an implanted antitachycardia DDDRP pacemaker for patients with sick sinus syndrome and paroxysmal ATA.


METHODS
In all 24 patients, a DDDRP pacemaker (Medtronic AT500/AT501) was implanted. APP algorithms were switched on at the implanting physician's discretion. During each pacemaker follow-up, information was saved to disk and the ATA burden between those patients with APP algorithms switched "ON" and "OFF" were compared. Reliability of ATA detection was determined by reviewing the stored electrograms and ATP efficacy was also reviewed. Both the pacemaker memory data and manual EGM retrieval were used for the analysis.


RESULTS
Complication-free survival at (17.63 +/- 8.79) months was 100%. In 12 patients APP was not turned "ON" until the latest follow-up, in 6 patients APP was switched "ON" at their first visit after implantation, and in another 6 patients APP was switched "ON" after a median follow-up of 9.29 months. There were 97 367 episodes of ATA detected by the devices, of those with stored atrial electrograms the correct classification of ATA was (76.77 +/- 20.52)%. The percentage of atrial pacing with APP algorithms turned on was (87.95 +/- 20.93)%, which was significantly higher than that in patients with APP "OFF" (50.73 +/- 34.46)% (P < 0.01). ATP efficacy was (50.27 +/- 19.29)%. However, the ATA burden (14.73% vs 16.52%, or 7.52 hours vs 6.58 hours per week, P > 0.05) and the longest duration of single ATA episode (27.27 hours vs 20.75 hours, P > 0.05) were not significantly different between those patients with APP "ON" and "OFF". No proarrhythmic effect or major cardiovascular event was observed.


CONCLUSIONS
The antitachycardia DDDRP pacemaker correctly detects and diagnoses about 75% of the ATA episodes, while the ATP therapy successfully terminates atrial tachycardia or flutter in about 50% of attacks. However, there is no difference in ATA burden with the APP algorithms and high incidence of atrial pacing. As a non-curative therapy strategy, this high-cost device may only be used in strictly selected indication patients in addition to other treatments of ATA.
Bai
Rong
R
Department of Cardiology, Tong-Ji Hospital, Tong-Ji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China. bairong74@yahoo.com.cn
Wang
Tie-mao
TM
Lin
Li
L
Kam
Ruth
R
Wee
Siong teo
St
Wang
Lin
L
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D012189:Retrospective Studies; D016896:Treatment Outcome