title: AAIsafeR limits ventricular pacing in unselected patients.
abstract: BACKGROUND
  Dedicated pacing modes, such as AAIsafeR, prevent ventricular (V) pacing in selected patients. We report our experience in consecutive unselected patients.
  
  
  METHODS
  All data collected in recipients of Symphony DR 2550 pacemakers (ELA Medical, Montrouge, France) were retrospectively analyzed. At each visit, the percentage of V and atrial (A) pacing and the number of endless-loop tachycardia (ELT) episodes detected by the device were retrieved. Data were pooled according to pacing mode and compared with non-paired Student's t-test. Between April 2004 and July 2005, our center recruited 147 patients (mean age = 80 +/- 9 years, 54% men) treated for AV block (n = 58), sinus node dysfunction (n = 48) or other indications (n = 41). Mean age at implant was 80 +/- 9 years, and 54% were men. AAIsafeR(R) was programmed in 96 patients, DDD(R) in 43, DDI in 7, and DDD/AMC in 1 patient. In DDD mode, the mean resting AV delay was set at 150 +/- 17 ms. Patients were seen 1 month after implantation of the pacing system to verify its proper function, and every 6 months thereafter. At each follow-up, the percentage of ventricular and atrial pacing, and the number of ELT detected by the device, were recorded.
  
  
  RESULTS
  The mean follow-up was 7 +/- 6 months (range 1-21). No device was reprogrammed from AAIsafeR(R) to DDDI(R) because of permanent AF. Only 6 devices (6.25%) were automatically reprogrammed from AAIsafeR(R) to DDD(R) during follow-up due to permanent AV block. An empirical choice of AAIsafeR pacing mode at the time of implantation was effective in 94% of patients, allowing a significant decrease in the percentage of V pacing. AAIsafeR versions 1 or 2 significantly decreased the percentage of V pacing (9 +/- 21%) compared with DDD (95 +/- 14%), DDD/AMC (31 +/- 34%), and DDI (87 +/- 20%) pacing (P < 0.00001). The mean percentage of V pacing was 12 +/- 24% (median 0%, range 0-94) in AAIsafeR1 versus 4 +/- 12% (median 0%, range 0-52) in AAIsafeR2 (P = .055). In 16 devices upgraded from AAIsafeR version 1 to version 2, with follow-up analyzable in both modes, the mean percentage of V pacing decreased from 6.4 +/- 15.1% to 2.6 +/- 9.7% (ns). No adverse effect related to the AAIsafeR modes was observed. No patient reported palpitation, dyspnea, or lightheadedness attributable to overdrive pacing by the AF prevention algorithms, and there was no rehospitalization, need for cardioversion, device-related complication, or death.
  
  
  CONCLUSIONS
  In unselected pacemaker recipients, AAIsafeR reliably prevented V pacing compared with other pacing modes. No adverse effects were reported by any patient. Furthermore, maintaining spontaneous AV conduction protected the patients against ELT episodes.
authors.affiliation: Clinique Alleray-Labrouste, Paris, France. guy.pioger2@wanadoo.fr
authors.forename: Guy
authors.initials: G
authors.lastname: Pioger
authors.forename: Gérard
authors.initials: G
authors.lastname: Leny
authors.forename: Rémi
authors.initials: R
authors.lastname: Nitzsché
authors.forename: Alain
authors.initials: A
authors.lastname: Ripart
mesh_terms: D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000517:prevention & control*; D054537:Atrioventricular Block / Q000628:therapy; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D012189:Retrospective Studies; D012804:Sick Sinus Syndrome / Q000628:therapy; D013610:Tachycardia; D016277:Ventricular Function, Left