title: The effect of atrial preference pacing on paroxysmal atrial fibrillation incidence in myotonic dystrophy type 1 patients: a prospective, randomized, single-bind cross-over study.
abstract: OBJECTIVE
  Atrial Preference Pacing (APP) is a pacemaker (PM) algorithm that supports a continuous atrial stimulation instead of a spontaneous atrial rhythm to prevent supraventricular tachyarrhythmias. The role of the APP in the prevention of atrial fibrillation (AF) is still controversial. The aim of our study was to evaluate the effect of preventive atrial pacing on AF incidence in myotonic dystrophy type I patients during a 12-month follow-up period.
  
  
  RESULTS
  We studied 40 patients with myotonic dystrophy type 1 (MD1) who underwent dual-chamber PM implantation for first- and second-degree atrioventricular block. After a 1-month stabilization period, they were randomized to APP algorithm programmed OFF or ON for 6 months each, using a cross-over design. The number of AF episodes during active treatment (APP ON phases) was lower than those registered during no treatment (APP OFF phases). No statistically significant difference was found in AF episodes duration between the two phases. During the APP OFF phases and APP ON phases, the atrial pacing percentage was 0 and 98%, respectively, while the ventricular pacing percentage did not show statistically significant difference (10 vs. 8%, P =0.2). Atrial premature beats count was significantly greater during APP OFF phases than during APP ON phases. Lead parameters remained stable over time and there were no lead-related complications.
  
  
  CONCLUSIONS
  Based on these 12-month follow-up data, it is concluded that APP is an efficacy algorithm for preventing paroxysmal AF in MD1 patients who underwent dual-chamber PM implantation for atrioventricular conduction disorders.
authors.affiliation: Department of Cardiology, Second University of Naples-Monaldi Hospital, Naples, Italy. v.p.russo@libero.it
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Russo
authors.forename: Anna
authors.initials: A
authors.lastname: Rago
authors.forename: Luisa
authors.initials: L
authors.lastname: Politano
authors.forename: Nadia
authors.initials: N
authors.lastname: Della Cioppa
authors.forename: Maria Giovanna
authors.initials: MG
authors.lastname: Russo
authors.forename: Paolo
authors.initials: P
authors.lastname: Golino
authors.forename: Raffaele
authors.initials: R
authors.lastname: Calabrò
authors.forename: Gerardo
authors.initials: G
authors.lastname: Nigro
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications* / Q000517:prevention & control*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009223:Myotonic Dystrophy / Q000150:complications* / Q000628:therapy*; D011446:Prospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome