title: Efficacy of automatic mode switching in DDDR mode pacemakers: the most 2 study.
abstract: BACKGROUND
  Effective automatic mode switching (AMS) algorithms capable of detecting a range of supraventricular tachyarrhythmias is important given evidence of atrial fibrillation (AF), atrial flutter (AFL), and atrial tachycardia (AT) post-implantation of pacemakers.
  
  
  OBJECTIVE
  The aim of the study was to assess the efficacy, defined as ability to detect a specific atrial rate and activate AMS, of five different AMS mechanisms during simulation of AF, AFL, and AT.
  
  
  METHODS
  A total of 48 subjects (35 men, 13 women; mean age: 69 +/- 8 years) implanted with DDDR pacemakers utilizing five different AMS mechanisms (mean atrial rate, rate cut-off, complex 'fallback' algorithm, retriggerable atrial refractory period, and physiological band 'beat-to-beat') were tested using an external electronic device that simulated the occurrence of supraventricular tachyarrhythmias. AF, AFL, and AT were simulated by delivering low voltage pulse trains at 350, 250 and 160 beats/min, respectively.
  
  
  RESULTS
  Mean efficacy for all AMS mechanisms was 81% [range: 57% to 100%] at 350 beats/min, 81% [range: 57-100%] at 250 beats/min, and 79% [range: 57-100%] at 160 beats/min. The AMS mechanisms that yielded 100% efficacy were the rate cut-off and physiological band 'beat-to-beat.'
  
  
  CONCLUSIONS
  Not all AMS algorithms are equally efficacious at detecting atrial arrhythmias and subsequently activating AMS. Our results suggest that the most efficacious AMS algorithms are those that use rate cut-off and physiological band 'beat-to-beat' to detect supraventricular tachyarrhythmias.
authors.affiliation: Department of Cardiology, Federico II University Naples, Via Pansini 5, 80131 Naples, Italy. santomau@unina.it
authors.forename: Maurizio
authors.initials: M
authors.lastname: Santomauro
authors.forename: Luca
authors.initials: L
authors.lastname: Ottaviano
authors.forename: Alessio
authors.initials: A
authors.lastname: Borrelli
authors.forename: Gennaro
authors.initials: G
authors.lastname: Galasso
authors.forename: Carlo
authors.initials: C
authors.lastname: Duilio
authors.forename: Nicola
authors.initials: N
authors.lastname: Monteforte
authors.forename: Luigi
authors.initials: L
authors.lastname: Padeletti
authors.forename: Annibale Sandro
authors.initials: AS
authors.lastname: Montenero
authors.forename: Peter
authors.initials: P
authors.lastname: Andrew
authors.forename: Massimo
authors.initials: M
authors.lastname: Chiariello
mesh_terms: D000368:Aged; D000465:Algorithms; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000517:prevention & control*; D013813:Therapy, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome