Journal Article

No evidence of automatic atrial overdrive pacing efficacy on reduction of paroxysmal atrial fibrillation

Willem de Voogt, Norbert van Hemel, Philip de Vusser, Georges H. Mairesse, Rob van Mechelen, Juhani Koistinen, Arjan van den Bos, Indrek Roose, Jüri Voitk, Sinikka Yli-Mäyry, Dirk Stockman, Dia El Allaf, Hung-Fat Tse and Chu-Pak Lau

in EP Europace

Published on behalf of European Heart Rhythm Association of the European Society of Cardiology (ESC)

Volume 9, issue 9, pages 798-804
Published in print September 2007 | ISSN: 1099-5129
Published online August 2007 | e-ISSN: 1532-2092 | DOI: http://dx.doi.org/10.1093/europace/eum149
No evidence of automatic atrial overdrive pacing efficacy on reduction of paroxysmal atrial fibrillation

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Aims Paroxysmal atrial fibrillation (PAF) is frequently encountered in pacemaker patients, most commonly in sick sinus syndrome. The combination of site-specific pacing in conjunction with an overdrive algorithm combined with antiarrhythmic drugs on the incidence of PAF in patients with a conventional indication for pacing is unknown.

Methods and results Patients with pacemaker indication and PAF received a DDDR-pacemaker, which included an automatic atrial overdrive (AO) algorithm. The atrial lead was implanted in either the right atrial appendage (RAA) (n = 83) or the right low-atrial septum (LAS) (n = 94). The algorithm was switched on or off in a 3 month, single blind crossover design and antiarrhythmic drugs were kept stable. A control group of 96 patients (LAS, n = 14; RAA, n = 84) without PAF served as controls to assess any proarrhythmic effect of overdrive pacing. Atrial fibrillation (AF) burden defined as cumulative time in mode switch was not reduced during automatic AO from either the RAA or from the LAS. The reduction was not effective both for AF of short (<24 h) and long (≥24 h) duration. There was no atrial proarrhythmia induced by the overdrive algorithm in the control group.

Conclusions We could not demonstrate a reduction of AF burden defined as cumulative time in AF by the AO algorithm, in patients who are paced for standard indications and PAF, neither from the RAA nor from the LAS.

Keywords: Paroxysmal atrial fibrillation; Atrial fibrillation; Pacing; Alternative site pacing; Atrial overdrive algorithm

Journal Article.  4686 words.  Illustrated.

Subjects: Cardiovascular Medicine

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