title: New-generation atrial antitachycardia pacing (Reactive ATP) is associated with reduced risk of persistent or permanent atrial fibrillation in patients with bradycardia: Results from the MINERVA randomized multicenter international trial.
abstract: BACKGROUND
  Atrial fibrillation (AF) is a frequent comorbidity in patients with pacemaker and is a recognized cause of mortality, morbidity, and quality-of-life impairment. The international MINimizE Right Ventricular pacing to prevent Atrial fibrillation and heart failure trial established that atrial preventive pacing and atrial antitachycardia pacing (DDDRP) in combination with managed ventricular pacing (MVP) reduce permanent AF occurrence in comparison with standard dual-chamber pacing (DDDR).
  
  
  OBJECTIVE
  We aimed to determine the role of new-generation atrial antitachycardia pacing (Reactive ATP) in preventing AF disease progression.
  
  
  METHODS
  Patients with dual-chamber pacemaker and with previous atrial tachyarrhythmias were randomly assigned to DDDR (n = 385 (33%)), MVP (n = 398 (34%)), or DDDRP+MVP (n = 383 (33%)) group. The incidence of permanent AF, as defined by the study investigator, or persistent AF, defined as ≥7 consecutive days with AF, was estimated using the Kaplan-Meier method, while its association with patients' characteristics was evaluated via multivariable Cox regression.
  
  
  RESULTS
  At 2 years, the incidence of permanent or persistent AF was 26% (95% confidence interval [CI] 22%-31%) in the DDDR group, 25% (95% CI 21%-30%) in the MVP group, and 15% (95% CI 12%-20%) in the DDDRP+MVP group (P < .001 vs. DDDR; P = .002 vs. MVP). Generalized estimating equation-adjusted Reactive ATP efficacy was 44.4% (95% CI 41.3%-47.6%). Multivariate modeling identified high Reactive ATP efficacy (>44.4%) as a significant predictor of reduced permanent or persistent AF risk (hazard ratio 0.32; 95% CI 0.13-0.781; P = .012) and episodes' characteristics, such as long atrial arrhythmia cycle length, regularity, and the number of rhythm transitions, as predictors of high ATP efficacy.
  
  
  CONCLUSIONS
  In patients with bradycardia, DDDRP+MVP delays AF disease progression, with Reactive ATP efficacy being an independent predictor of permanent or persistent AF reduction.
authors: Institute of Internal Medicine and Cardiology, University of Florence, Florence, Italy.
authors: Luigi
authors: L
authors: Padeletti
authors: Akademisches Lehrkrankenhaus der Elisabethinen, Linz, Austria.
authors: Helmut
authors: H
authors: Pürerfellner
authors: Department of Cardiology, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors: Lluis
authors: L
authors: Mont
authors: Kennemer Gasthuis, Haarlem, The Netherlands.
authors: Raymond
authors: R
authors: Tukkie
authors: Third Department of Cardiology, Athens University School of Medicine, Athens, Greece.
authors: Antonis S
authors: AS
authors: Manolis
authors: Cardiology Department, S. Filippo Neri Hospital, Rome, Italy.
authors: Renato
authors: R
authors: Ricci
authors: Institute of Cardiology, Maggiore Hospital, Crema, Italy.
authors: Giuseppe
authors: G
authors: Inama
authors: Cardiology Department, G. Mazzini Hospital, Teramo, Italy.
authors: Paolo
authors: P
authors: Serra
authors: Department of Cardiology, Maasstad Ziekenhuis, Rotterdam, The Netherlands.
authors: Mike G
authors: MG
authors: Scheffer
authors: Hospital Distrital de Santarém, Santarém, Portugal.
authors: Vitor
authors: V
authors: Martins
authors: Medtronic Inc., Minneapolis, Minnesota.
authors: Eduardo N
authors: EN
authors: Warman
authors: Medtronic Clinical Operations, Milan, Italy.
authors: Marco
authors: M
authors: Vimercati
authors: Medtronic EMEA Regional Clinical Centre, Rome, Italy.
authors: Andrea
authors: A
authors: Grammatico
authors: Institute of Cardiology, S. Orsola-Malpighi University Hospital, Bologna, Italy. Electronic address: giuseppe.boriani@unibo.it.
authors: Giuseppe
authors: G
authors: Boriani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D001919:Bradycardia / Q000150:complications / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Antitachycardia pacing; Atrial fibrillation; Pacemaker; Reactive ATP