title: Atrial overdrive pacing and incidence of heart failure-related adverse events in permanently paced patients.
abstract: 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.
authors.affiliation: Medical Clinic, Friedrich-Ebert-Hospital, Friesenstrasse 11, D 24531 Neumünster, Germany. andreas.schuchert@fek.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Schuchert
authors.forename: Mark
authors.initials: M
authors.lastname: Carlson
authors.forename: John
authors.initials: J
authors.lastname: Ip
authors.forename: John
authors.initials: J
authors.lastname: Messenger
authors.forename: Scott
authors.initials: S
authors.lastname: Beau
authors.forename: Steven
authors.initials: S
authors.lastname: Kalbfleisch
authors.forename: Pierre
authors.initials: P
authors.lastname: Gervais
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Cameron
authors.forename: Aurelio
authors.initials: A
authors.lastname: Duran
authors.forename: Jesus
authors.initials: J
authors.lastname: Val-Mejias
authors.forename: Judith
authors.initials: J
authors.lastname: Mackall
authors.forename: Michael
authors.initials: M
authors.lastname: Gold
mesh_terms: 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