Right atrial preventive and antitachycardia pacing for prevention of paroxysmal atrial fibrillation in patients without bradycardia: a randomized study.
OBJECTIVE
To investigate the efficacy of preventive and antitachycardia pacing (ATP) in patients with symptomatic paroxysmal atrial fibrillation (AF) without bradyarrhythmias.


RESULTS
In this randomized cross-over pilot study, we randomized 38 symptomatic paroxysmal AF patients 'without' bradyarrhythmias to atrial pacing lower rate 70 ppm and prevention and ATP therapies ON or to atrial pacing lower rate 34 ppm and prevention and ATP therapies OFF during 12 weeks with a 4 week washout period in between. The atrial lead was preferably placed in the inter-atrial septum. Antiarrhythmic drugs were continued during the study. Primary endpoint was AF burden. Mean age was 62 +/- 9 years and 27 (71%) patients had lone AF. Septal lead placement was accomplished in 26 (68%) patients. During the treatment ON, there was a trend for AF burden reduction [from median 3.3% (1.0-15.2) to 2.4% (0.2-12.2), P = 0.06, reduction 27%]. If septal lead placement was accomplished, AF burden reduction was statistically significant [44% reduction, from median 2.5% (1.0-8.0) to 1.4% (0.2-8.4), P = 0.03]. Quality of life and symptoms did not change, also not in the septal group.


CONCLUSIONS
A hybrid therapy of preventive and ATP pacing and antiarrhythmic drugs may significantly reduce but not abolish AF burden if septal pacing is realized.
Hemels
Martin E W
ME
Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
Ruiter
Jaap H
JH
Molhoek
G Peter
GP
Veeger
Nic J G M
NJ
Wiesfeld
Ans C P
AC
Ranchor
Adelita V
AV
van Trigt
Marcel
M
Pilmeyer
Art
A
Van Gelder
Isabelle C
IC
D000368:Aged; D000465:Algorithms; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000517:prevention & control* / Q000628:therapy*; D054087:Atrial Septum / Q000503:physiopathology; D001919:Bradycardia / Q000503:physiopathology*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D003131:Combined Modality Therapy; D018592:Cross-Over Studies; D004554:Electric Countershock / Q000379:methods; D005221:Fatigue / Q000503:physiopathology; D005260:Female; D006325:Heart Atria / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011788:Quality of Life
D000889:Anti-Arrhythmia Agents