Atrial overdrive pacing and incidence of heart failure-related adverse events in permanently paced patients.
BACKGROUND
Atrial overdrive pacing algorithms may be effective in preventing or suppressing atrial fibrillation (AF). However, the maintenance of a heart rate incessantly faster than spontaneous could induce left ventricular (LV) dysfunction and promote heart failure (HF) on the long term.


OBJECTIVE
This post hoc analysis examined the effects of a new overdrive algorithm on the incidence of HF-related adverse events in 411 patients enrolled in the ADOPT-A trial.


METHODS
The AF Suppression algorithm was randomly programmed ON in 209 patients (treatment group) versus OFF in 202 patients (control group). The incidence of HF-related adverse events and HF-related deaths over a 6-month follow-up was compared between the two groups. Patients with versus without HF-related clinical events were also compared to each other within each group.


RESULTS
There were eight HF-related adverse clinical events (3.8%) in the treatment group and 11 (5.4%) in the control group, including four HF-related deaths (1.9 vs. 2.0%) in each group during follow-up. Baseline NYHA functional class in patients with versus without HF-related adverse events was 1.4 +/- 0.5 versus 1.5 +/- 0.7 in the control, and 1.5 +/- 0.8 versus 1.5 +/- 0.6 in the treatment group. LV ejection fraction (EF) was 49 +/- 7% in patients with, versus 57 +/- 12% in patients without HF-related adverse events, in the control group, and 43 +/- 14% in patients with, versus 56 +/- 13% in patients without HF-related adverse events, in the treatment group. LVEF was lowest and similar in both groups among patients who died from HF (35 +/- 10% in the control and 38 +/- 27% in the treatment group).


CONCLUSIONS
In ADOPT-A, HF-related clinical events and deaths were related to LV dysfunction and not to atrial pacing overdriven by the AF suppression algorithm.
Schuchert
Andreas
A
Medical Clinic, Friedrich-Ebert-Hospital, Friesenstrasse 11, D 24531 Neumünster, Germany. andreas.schuchert@fek.de
Carlson
Mark
M
Ip
John
J
Messenger
John
J
Beau
Scott
S
Kalbfleisch
Steven
S
Gervais
Pierre
P
Cameron
Douglas A
DA
Duran
Aurelio
A
Val-Mejias
Jesus
J
Mackall
Judith
J
Gold
Michael
M
D000368:Aged; D000465:Algorithms; D001281:Atrial Fibrillation / Q000628:therapy*; D002303:Cardiac Output, Low / Q000453:epidemiology*; D002304:Cardiac Pacing, Artificial; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D010138:Pacemaker, Artificial; D015995:Prevalence; D016037:Single-Blind Method; D016896:Treatment Outcome