title: Atrial Rate-Responsive Pacing and Incidence of Sustained Atrial Arrhythmias in Patients with Implantable Cardioverter Defibrillators.
abstract: Atrial rate-responsive pacing (RRP) has proved to be safe in pacemaker recipients with chronotropic incompetence. Although RRP is available in all current implantable cardioverter defibrillators (ICDs), the outcomes of this pacing mode in ICD patients are unknown. The aim is to evaluate the relationship between atrial RRP and atrial arrhythmias in ICD recipients.
  
  
  
  Dual-chamber and triple-chamber ICD patients were included in this multicenter cohort study. Patients with permanent atrial fibrillation (AF) or VVI pacing mode were excluded. The number and duration of atrial tachycardia (AT)/AF episodes were assessed.
  
  
  
  Data from 415 patients and 80,707 AT/AF episodes (median duration: 0.4 hours) were collected after a 21.3 ± 14.1-month follow-up. Atrial RRP was programmed in 90 (21.7%) patients and was associated with a higher atrial pacing percentage in the overall study population (51.2 ± 33.8% vs 18.4 ± 25.7%, P < 0.001) and to a higher ventricular pacing percentage among dual-chamber devices (22.3 ± 37.6% vs 9.3 ± 25%, P < 0.001). Independent factors associated with sustained AT/AF episodes (>23 hours) were previous AF (odds ratio [OR]: 7.98; 95% confidence interval [CI]: 4.11-15.47; P < 0.001) and atrial RRP (OR: 3.58; 95% CI: 1.82-7.03; P < 0.001). RRP was related to a lower sustained AT/AF episodes-free survival both in patients with a history of AF (43% vs 70%, P = 0.035) and without a history of AF (82% vs 97%, P = 0.004) at 2 years.
  
  
  
  Atrial RRP in ICD patients was related to a higher incidence of sustained atrial arrhythmias. This pacing mode may have an atrial proarrhythmic effect on ICD patients, especially among those with a history of AF.
authors.affiliation: Cardiology Department, University Hospital 12 de Octubre, Madrid, Spain.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Fontenla
authors.affiliation: Cardiology Department, University Hospital 12 de Octubre, Madrid, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Salguero
authors.affiliation: Cardiology Department, University Hospital Araba-Txagorritxu, Vitoria-Gasteiz, Alava, Spain.
authors.forename: Jose B
authors.initials: JB
authors.lastname: Martinez-Ferrer
authors.affiliation: Cardiology Department, University Hospital of Canarias, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain.
authors.forename: Anibal
authors.initials: A
authors.lastname: Rodriguez
authors.affiliation: Cardiology Department, Hospital Virgen de la Victoria, Malaga, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Alzueta
authors.affiliation: Cardiology Department, University Hospital of Vigo, Vigo, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Garcia
authors.affiliation: Cardiology Department, Hospital of Navarra, Pamplona, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Basterra
authors.affiliation: Cardiology Department, Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Romero
authors.affiliation: Cardiology Department, Hospital Infanta Cristina, Badajoz, Spain.
authors.forename: Joaquin Fernandez DE LA
authors.initials: JF
authors.lastname: Concha
authors.affiliation: Cardiology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Viñolas
authors.affiliation: Cardiology Department, Hospital Clinico San Carlos, Madrid, Spain.
authors.forename: Julian
authors.initials: J
authors.lastname: Villacastin
authors.affiliation: Cardiology Department, University Hospital 12 de Octubre, Madrid, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Lopez-Gil
authors.affiliation: Cardiology Department, University Hospital 12 de Octubre, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Arribas
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000503:physiopathology; D015331:Cohort Studies; D017147:Defibrillators, Implantable; D005260:Female; D006325:Heart Atria / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged
keywords: atrial arrhythmias; atrial fibrillation; implantable cardioverter defibrillator; rate-responsive pacing