title: Reduction of atrial fibrillation burden by atrial overdrive pacing: experience with an improved algorithm to reduce early recurrences of atrial fibrillation.
abstract: OBJECTIVE
  Two independent studies have revealed a potential limitation of post-mode switch overdrive pacing (PMOP), which is its delayed start.
  
  
  RESULTS
  We conducted a prospective, randomized, single blind, crossover design study (the post-long pause overdrive pacing study) to test the efficacy of an improved version of PMOP (PMOP(enhanced)). A total of 45 patients were enrolled, of whom 41 were analysed. The median number of atrial tachycardia/atrial fibrillation (AT/AF) episodes per day (1.38 vs. 1.19), the median number of early recurrences of atrial fibrillation (ERAF) per day (0.56 vs. 0.51), and the median AT/AF burden (time per day spent in AT/AF) (2.47 vs. 2.51 h) were not significantly different during the control and active study periods. Based on the median number of episodes per week recorded 90 days prior to enrollment, the patients were stratified by the median and then split into two groups, Group A (lower 2-Quartiles) and Group B (upper 2-Quartiles). The median AT/AF burden was significantly lower in Group B during the active study period (3.71 vs. 1.71 h, P = 0.02).The median number of AT/AF episodes per day and the median number of ERAF per day in Group B showed a trend towards reduction when the algorithm was turned on (3.79 vs. 2.44 and 2.77 vs. 1.86, respectively). In contrast, in Group A we did not demonstrate any difference in AT/AF frequency, ERAF frequency, or burden.
  
  
  CONCLUSIONS
  The main finding of this study is that temporary overdrive pacing at 90 bpm for 10 min starting just prior to device-classified AT/AF termination does not show a positive effect on the overall study population. However, when enabled in patients who suffer from a high percentage of ERAF, a significant reduction in the AT/AF burden could be demonstrated. Based on these findings, further prospective studies on a more targeted patient population are needed to confirm our results.
authors.affiliation: 1Internal Department/Division of Cardiology, Public Hospital Elisabethinen, Academic Teaching Hospital, Fadingerstrasse 1, A-4010 Linz, Austria. helmut.puererfellner@elisabethinen.or.at
authors.forename: Helmut
authors.initials: H
authors.lastname: Pürerfellner
authors.forename: Lubos
authors.initials: L
authors.lastname: Urban
authors.forename: Gerjan
authors.initials: G
authors.lastname: de Weerd
authors.forename: Jaap
authors.initials: J
authors.lastname: Ruiter
authors.forename: Johan
authors.initials: J
authors.lastname: Brandt
authors.forename: Ales
authors.initials: A
authors.lastname: Havlicek
authors.forename: Burkhard
authors.initials: B
authors.lastname: Hügl
authors.forename: Jos
authors.initials: J
authors.lastname: Widdershoven
authors.forename: Lilian
authors.initials: L
authors.lastname: Kornet
authors.forename: Roger
authors.initials: R
authors.lastname: Kessels
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001281:Atrial Fibrillation / Q000517:prevention & control*; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D055502:Secondary Prevention; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D013813:Therapy, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome