No evidence of automatic atrial overdrive pacing efficacy on reduction of paroxysmal atrial fibrillation.
OBJECTIVE
Paroxysmal atrial fibrillation (PAF) is frequently encountered in pacemaker patients, most commonly in sick sinus syndrome. The combination of site-specific pacing in conjunction with an overdrive algorithm combined with antiarrhythmic drugs on the incidence of PAF in patients with a conventional indication for pacing is unknown.


RESULTS
Patients with pacemaker indication and PAF received a DDDR-pacemaker, which included an automatic atrial overdrive (AO) algorithm. The atrial lead was implanted in either the right atrial appendage (RAA) (n = 83) or the right low-atrial septum (LAS) (n = 94). The algorithm was switched on or off in a 3 month, single blind crossover design and antiarrhythmic drugs were kept stable. A control group of 96 patients (LAS, n = 14; RAA, n = 84) without PAF served as controls to assess any proarrhythmic effect of overdrive pacing. Atrial fibrillation (AF) burden defined as cumulative time in mode switch was not reduced during automatic AO from either the RAA or from the LAS. The reduction was not effective both for AF of short (<24 h) and long (> or =24 h) duration. There was no atrial proarrhythmia induced by the overdrive algorithm in the control group.


CONCLUSIONS
We could not demonstrate a reduction of AF burden defined as cumulative time in AF by the AO algorithm, in patients who are paced for standard indications and PAF, neither from the RAA nor from the LAS.
Department of Cardiology, St Lucas Andreas Hospital, J Toorpstraat 164, 1061AE, Amsterdam, The Netherlands. w.g.devoogt@planet.nl
Willem
W
de Voogt
Norbert
N
van Hemel
Philip
P
de Vusser
Georges H
GH
Mairesse
Rob
R
van Mechelen
Juhani
J
Koistinen
Arjan
A
van den Bos
Indrek
I
Roose
Jüri
J
Voitk
Sinikka
S
Yli-Mäyry
Dirk
D
Stockman
Dia
D
El Allaf
Hung-Fat
HF
Tse
Chu-Pak
CP
Lau
D000368:Aged; D000465:Algorithms; D000889:Anti-Arrhythmia Agents / Q000494:pharmacology; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000628:therapy*; D016275:Atrial Function; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002309:Cardiology / Q000379:methods*; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D013614:Tachycardia, Paroxysmal / Q000503:physiopathology* / Q000628:therapy*; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents