A New Pacing Algorithm for Overdrive Suppression of Atrial Fibrillation

Abstract

Constant rapid pacing may suppress arrhythmias, but it is usually poorly tolerated in the long term. We report a pilot study of a new pacing algorithm for overdrive suppression of atrial premature complexes (APCs) and atrial fibrillation (AF), which prevents postextrasystolic pauses and varies the pacing rate in response to the frequency of APCs. The algorithm was tested in a multiple crossover study for 24 hours in dual chamber pacemakers implanted in 70 patients. Comparison was made on ambulatory recordings between the number of atrial arrhythmias commencing with the algorithm active and inactive. In all cases, the algorithm functioned as designed. No patient was aware of its operation, and no malignant arrhythmias were induced. The 36 recordings that showed atrial arrhythmia were included for analysis. The effects of the algorithm were: APCs (estimated from pacemaker statistics) reduced in 18 patients, increased in 8 (P = 0.02); atrial salvos reduced in 12, increased in 4 (P = 0.041); and AF reduced in 11, increased in 8 (P = NS). In all patients with frequent AF (> 5 episodes in total), fewer episodes occurred when the algorithm was active. We conclude that the algorithm is safe and well tolerated, reduces atrial ectopic activity, and may reduce the frequency of sustained atrial fibrillation.

Effects of Right Atrial Pacing Preference in Prevention of Paroxysmal Atrial Fibrillation

“…The role of a true overdrive atrial pacing algorithm was first evaluated by Murgatroyd et al, who found that the APP algorithm provides additional benefit. 7 This algorithm allows the pacemaker to maintain a pacing rate slightly higher than the sinus rate. As a result, a high percentage of atrial pacing is achieved.…”

“…Atrial pacing has been shown to prevent paroxysmal AF. [4][5][6][7] Overdrive atrial pacing is thought to prevent AF triggered by bradycardia and premature atrial beats. The Atrial Pacing Preference™ (APP; Guidant, St Paul, MN, USA) algorithm allows the pacemaker to maintain a pacing rate slightly higher than the sinus rate.…”

Implanted Devices and Atrial Fibrillation

“…Moreover, some effects on atrial remodeling, although little in magnitude, have been demonstrated. Other algorithms, such as the Atrial Preference Pacing algorithm (Medtronic, Minneapolis, MN) failed to show any reduction in the number of modeswitching episodes and symptomatic episodes despite a reduction of premature atrial beats [38].…”

Pacing Therapy for Prevention of Atrial Fibrillation

“…It is believed that atrial premature contraction will be reduced following by increasing the heart rate. Mugatroyd et al 71) reported that when an algorithm is used to increase the heart rate to 12.5% higher than the previous sinus rhythm at detection of atrial premature contraction by dissolving the resting phase after premature contraction was obtained, atrial premature contraction and the short run of atrial premature contraction were reduced by 69% and 75%, respectively. Unfortunately, no significant reduction of paroxysmal atrial fibrillation could be achieved.…”