title: The effect of atrial preference pacing on atrial fibrillation electrophysiological substrate in Myotonic Dystrophy type 1 population.
abstract: P-wave dispersion is a non invasive indicator of intra-atrial conduction heterogeneity producing substrate for reentry, which is a pathophysiological mechanism of atrial fibrillation. The relationship between P-wave dispersion (PD) and atrial fibrillation (AF) in Myotonic dystrophy type 1 (DM1) patients is still unclear. Atrial Preference Pacing (APP) is an efficient algorithm to prevent paroxysmal AF in patients implanted with dual-chamber pacemaker. Aim of our study was to evaluate the possible correlation between atrial preference pacing algorithm, P-wave dispersion and AF burden in DM1 patients with normal cardiac function underwent permanent dual-chamber pacemaker implantation. We enrolled 50 patients with DM1 (age 50.3 ± 7.3; 11 F) underwent dual-chamber pacemaker implantation for various degree of atrioventricula block. The study population was randomized following 1 months stabilization period to APP algorithm features programmed OFF or ON. Patients were assessed every 3 months for the first year, and every 6 months thereafter up to 3 years. At each follow-up visit, we counted: the number of premature atrial beats, the number and the mean duration of AF episodes, AF burden and the percentage of atrial and ventricular pacing. APP ON Group showed lower number of AF episodes (117 ± 25 vs. 143 ± 37; p = 0.03) and AF burden (3059 ± 275 vs. 9010 ± 630 min; p < 0.04) than APP OFF Group. Atrial premature beats count (44903 ± 30689 vs. 13720 ± 7717 beats; p = 0.005) and Pwave dispersion values (42,1 ± 11 ms vs. 29,1 ± 4,2 ms, p = 0,003) were decreased in APP ON Group. We found a significant positive correlation between PD and AF burden (R = 0,8, p = 0.007). Atrial preference pacing algorithm, decreasing the number of atrial premature beats and the P-wave dispersion, reduces the onset and perpetuator factors of AF episodes and decreases the AF burden in DM1 patients underwent dual chamber pacemaker implantation for various degree of atrioventricular blocks and documented atrial fibrillation.
authors: Chair of Cardiology, Second University of Napoli, Monaldi Hospital, Napoli, Italy;
authors: Vincenzo
authors: V
authors: Russo
authors: Chair of Cardiology, Second University of Napoli, Monaldi Hospital, Napoli, Italy;
authors: Gerardo
authors: G
authors: Nigro
authors: Chair of Cardiology, Second University of Napoli, Monaldi Hospital, Napoli, Italy;
authors: Federica
authors: F
authors: DI Meo
authors: Chair of Cardiology, Second University of Napoli, Monaldi Hospital, Napoli, Italy;
authors: Andrea Antonio
authors: AA
authors: Papa
authors: Chair of Cardiology, Second University of Napoli, Monaldi Hospital, Napoli, Italy;
authors: Nadia Della
authors: ND
authors: Cioppa
authors: Cardiology Department, "Luigi Sacco" Hospital, Milano, Italy;
authors: Riccardo
authors: R
authors: Proietti
authors: Chair of Cardiology, Second University of Napoli, Monaldi Hospital, Napoli, Italy;
authors: Maria Giovanna
authors: MG
authors: Russo
authors: Chair of Cardiology, Second University of Napoli, Monaldi Hospital, Napoli, Italy;
authors: Raffaele
authors: R
authors: Calabrò
authors: Cardiomyology and Medical Genetics, Department of Experimental Medicine, Second University of Napoli, Italy.
authors: Luisa
authors: L
authors: Politano
mesh_terms: D000328:Adult; D000465:Algorithms; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D015150:Echocardiography, Doppler / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009223:Myotonic Dystrophy / Q000150:complications / Q000503:physiopathology; D018579:Patient Selection; D016896:Treatment Outcome
keywords: Myotonic Dystrophy; atrial fibrillation; atrial preference pacing