Increased base rate of atrial pacing for prevention of atrial fibrillation after implantation of a dual-chamber pacemaker: insights from the Atrial Overdrive Pacing Study.
OBJECTIVE
Different pacing sites and various algorithms have been utilized to prevent atrial fibrillation (AF) in pacemaker recipients. However, the optimal pacing rate settings have not yet been established. In this randomized, prospective, multicentre, single-blinded, cross over study, rate-adaptive pacing at a high base rate (BR) in patients, age 60 years or above, or a history of paroxysmal AF, who underwent dual-chamber (DDD) pacemaker implantation for standard pacing indications, was evaluated for prevention of AF.


RESULTS
In the study cohort of 145 patients implanted with DDD pacemakers with a programmable rest rate (RR) feature, the BR/RR settings were sequentially but randomly adjusted as follows: 60 bpm/Off for the baseline quarter (initial 3 months) and then to either 'A-B-C' or 'C-B-A' settings (A = 70/65 bpm, B = 70/Off, C = 80/65 bpm) for the subsequent quarters each of 3 months duration. Data on automatic mode switch episodes, device diagnostics, and a questionnaire evaluating pacemaker awareness and palpitations were collected. Ninety-nine patients, mean age 77 +/- 10 years, who completed the study protocol and followed for 12 months did not show significant differences in the number of mode switch episodes between any settings used. The percentage of atrial pacing was lower during baseline pacing compared to settings A, B, and C (P < 0.0001). Setting C produced a higher percentage of atrial pacing than A and B (P < 0.01). Although a higher percentage of atrial pacing correlated with a lower incidence of mode switch episodes, there was no statistically significant difference in the number of mode switch episodes between settings A, B, and C. There were no significant differences in the questionnaire scores relating to pacemaker awareness or palpitation.


CONCLUSIONS
Overdrive single-site pacing in the right atrium achieved by programming analysed settings in the present study did not reduce AF as assessed by mode switch episodes. Additionally, no change in the symptoms of arrhythmia or awareness of pacing was seen.
Kantharia
Bharat K
BK
Drexel University College of Medicine, Philadelphia, PA, USA. bkantharia@yahoo.com
Freedman
Roger A
RA
Hoekenga
David
D
Tomassoni
Gery
G
Worley
Seth
S
Sorrentino
Robert
R
Steinhaus
David
D
Wolkowicz
Joel M
JM
Syed
Zaffer A
ZA
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000503:physiopathology; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000517:prevention & control* / Q000628:therapy*; D001364:Awareness / Q000502:physiology; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D018592:Cross-Over Studies; D005260:Female; D006325:Heart Atria / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D011446:Prospective Studies; D012146:Rest / Q000502:physiology; D016037:Single-Blind Method; D011795:Surveys and Questionnaires