title: The relationship between right ventricular pacing and atrial fibrillation burden and disease progression in patients with paroxysmal atrial fibrillation: the long-MinVPACE study.
abstract: OBJECTIVE
  In patients requiring permanent pacemaker implantation for sinus node disease (SND) or atrioventricular (AV) block, right ventricular (RV) pacing has been demonstrated to increase the risk of developing atrial fibrillation (AF). The effects of RV pacing in patients with paroxysmal AF are less well defined. Short- and medium-term studies have suggested no significant correlation between RV pacing and atrial fibrillation burden (AFB) measurement; we sought to assess for an effect in the long-term.
  
  
  RESULTS
  Sixty-six patients were randomized to receive either conventional dual chamber pacing (DDDR, n = 33), or dual chamber minimal ventricular pacing (MinVP, n = 33), for a period of at least 1 year. Patients were reviewed every 6 months and all pacemaker data were downloaded. The primary outcome measures were device-derived AFB and progression to persistent AF. The mean duration of study follow-up was 1.4 ± 0.6 years. Mean ventricular pacing was less in the MinVP cohort compared with the DDDR cohort (5.8 vs. 74.0%, P < 0.001). At follow-up, the device-derived AFB was significantly lower in the MinVP cohort when compared with the DDDR cohort (12.8 ± 15.3% vs. DDDR 47.6 ± 42.2%, P < 0.001). Kaplan-Meier estimates of time to onset of persistent AF showed significant reductions in the rates of persistent AF for MinVP pacing (9%) when compared with conventional DDDR pacing (42%), P = 0.004.
  
  
  CONCLUSIONS
  Right ventricular pacing induces increased AFB in patients with paroxysmal AF in the long term. Dual chamber MinVP algorithms result in reduced AFB and reduced disease progression from paroxysmal to persistent AF in the long term.
authors.affiliation: Department of Cardiology, East Sussex Hospitals NHS Trust, Eastbourne BN21 2UD, UK.
authors.forename: Rick A
authors.initials: RA
authors.lastname: Veasey
authors.forename: Anita
authors.initials: A
authors.lastname: Arya
authors.forename: John
authors.initials: J
authors.lastname: Silberbauer
authors.forename: Vinoda
authors.initials: V
authors.lastname: Sharma
authors.forename: Guy W
authors.initials: GW
authors.lastname: Lloyd
authors.forename: Nikhil R
authors.initials: NR
authors.lastname: Patel
authors.forename: A Neil
authors.initials: AN
authors.lastname: Sulke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001281:Atrial Fibrillation / Q000503:physiopathology*; D054537:Atrioventricular Block / Q000628:therapy; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D010138:Pacemaker, Artificial; D012804:Sick Sinus Syndrome / Q000628:therapy; D013318:Stroke Volume / Q000502:physiology; D013997:Time Factors; D016896:Treatment Outcome