Canadian Trial of Physiological Pacing

Kerr, Charles R.; Connolly, Stuart J.; Abdollah, Hoshiar; Roberts, Robin S.; Gent, Michael; Yusuf, Salim; Gillis, Anne M.; Tang, Antony; Talajic, Mario; Klein, George J.; Newman, David

doi:10.1161/01.cir.0000109490.72104.ee

Cited by 176 publications

(30 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[8][9][10] We set out to evaluate the association of statin therapy and the risk of developing AF in patients implanted with permanent pacemakers, a population with a high incidence of AF. [11][12][13] …”

Section: Introductionmentioning

confidence: 99%

Association of statin therapy and the risk of atrial fibrillation in patients with a permanent pacemaker

Amit

Katz

Baron

et al. 2006

Clinical Cardiology

View full text Add to dashboard Cite

SummaryBackground: Recent studies have shown conflicting results regarding a protective effect of statin therapy on atrial fibrillation (AF).Hypothesis: We sought to determine whether statins are effective in reducing the risk of developing arrhythmia in a cohort of 264 patients (49% women, mean age [± standard deviation] 71 [± 12] years) with permanent pacemakers who are at high risk for AF.Methods: All patients who underwent implantation of a permanent pacemaker over a 3-year period were eligible for inclusion in the study. We excluded patients with AF at implantation, incomplete medication information, or less than a yearly follow-up visit. Atrial fibrillation was diagnosed by ECG documentation, pacemaker interrogation, and Holter monitoring. Statin treatment was verified through a central pharmacy-computerized database (for most patients) or by chart review. Of the 264 patients, 36% had coronary artery disease.Results: Atrial fibrillation developed in 70 patients (26%) at a median of 359 days post pacemaker implantation. The incidence rate for the first occurrence of AF post pacemaker implantation among patients treated and not treated with statins was 10.5 versus 9.8 events per 100 patient-years, respectively

show abstract

Section: Introductionmentioning

confidence: 99%

Association of statin therapy and the risk of atrial fibrillation in patients with a permanent pacemaker

Amit

Katz

Baron

et al. 2006

Clinical Cardiology

View full text Add to dashboard Cite

show abstract

“…Prospective randomized pacing trials reported significantly lower incidences of AF with physiological pacing than with ventricular pacing in patients with symptomatic bradycardia. [1][2][3] In patients with a history of AF, novel pacing strategies including sophisticated pacing algorithms were evaluated; however, their efficacy for AF suppression remains unclear. 4 -10 …”

mentioning

confidence: 99%

New Insights Into the Initiation of Atrial Fibrillation

et al. 2006

View full text Add to dashboard Cite

on behalf of the Atrial Fibrillation Therapy (AFT) Trial InvestigatorsBackground-This study investigated onset scenarios of atrial fibrillation (AF), the first phase of the Atrial Fibrillation Therapy (AFT) trial, to determine potential arrhythmogenic triggers as targets for atrial pacing algorithms that have been proposed for prevention of AF. Methods and Results-Ninety-eight patients (58 men; age 65Ϯ11 years) with recurrent, symptomatic, drug-refractory AF and a conventional pacemaker indication in 31 of 98 received a dual-chamber pacemaker. Using novel diagnostic pacemaker features AF onset scenarios were prospectively evaluated in 612 AF episodes during a 2-month monitoring period, with atrial pacing limited to 40 bpm. The most common onset scenario was premature atrial complexes (PACs) before AF (48% onsets per patient), followed by bradycardia (33%), sudden onset (17%), and tachycardia (0%). Combinations of onset scenarios were frequent (median 2 different scenarios per patient). A main study finding was the significance of repetitive AF, with 33% of onsets per patient being initiated within 5 minutes of a previous AF episode. Sudden onsets were more frequent among patients with than without repetitive AF (24% versus 0% onsets per patient, Pϭ0.011), whereas the proportion of PACs before AF was not statistically different (50% versus 37%, Pϭ0.52); however, patients with repetitive AF had more PACs per hour (72 versus 29, Pϭ0.023) and a higher number of AF episodes per day (17 versus 0, Pϭ0.001) and were more likely to have at least 1 PAC-related onset (90% versus 53%, PϽ0.0001). Conclusions-Novel diagnostic pacemaker features allowed a detailed individual analysis of rate and rhythm changes before AF and thus uncovered a substantial intraindividual and interindividual variability of AF onset scenarios.

show abstract

“…10 In contrast, the Canadian Trial of Physiological Pacing (CTOPP) showed a significant reduction in AF with physiological pacing. 11 The differences in outcome between these studies might be attributable to differences in design. Atrial pacing could reduce AF by pre- venting the changes in refractoriness caused by pauses or bradycardia, reducing intra-atrial conduction time, reducing dispersion of atrial refractoriness or reducing atrial ectopy.…”

Section: Discussionmentioning

confidence: 99%

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

Ogawa

Ishikawa

Matsushita

et al. 2008

Circ J

View full text Add to dashboard Cite

trial fibrillation (AF) occurs as a result of various mechanisms. 1 The initiating mechanisms of AF are considered to be bradycardia, that is, premature atrial contraction (PAC). Pharmacological treatment by class I or III antiarrhythmic drugs is usually effective. 2-3 Nonetheless, some patients are refractory to antiarrhythmic agents. 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. However, the efficacy and optimal setting of APP are unclear. The present multicenter study evaluates the efficacy of APP for the prevention of AF and the importance of optimal APP search interval setting in patients with sick sinus syndrome (SSS) and AF. Methods Patient SelectionThe inclusion criteria were those of the American College of Cardiology/American Heart Association class I or II pacemaker indications, together with a history of paroxysmal episodes of AF. Each patient underwent implantation of 2 permanent pacing leads. RA leads were placed at the RA appendage, and RV leads were placed at the RV apex. The exclusion criteria were: presence of chronic AF, <20 years old, pregnancy, undergoing dialysis, chronic renal failure, and severe heart failure. Antiarrhythmic drug therapy remained essentially unchanged in all patients. Written informed consent was obtained from all patients. The local ethics committee approved the study. Device CharacteristicsAll patients received a Model 1280™ (Guidant) combined with bipolar atrial and ventricular pacing leads. The device features included DDDR pacing and DDIR mode switch during atrial tachyarrhythmias and APP algorithm. The APP algorithm allows the pacemaker to maintain a pacing rate slightly higher than the sinus rate. When a Pwave is detected, the next pacing interval is shortened by 8 ms. When the pacing state is maintained for search intervals (ie, 2-128 programmable cycles), the pacing interval is prolonged by 8 ms. The APP pacing rate is limited to the Circ J 2008; 72: 700 -704 (Received July 22, 2007; revised manuscript received November 19, 2007; accepted December 11, 2007 Background Several preliminary studies have indicated that atrial pacing can prevent atrial tachyarrhythmias. The suggested mechanisms by which pacing may be effective include suppression of premature atrial beats. Methods and ResultsThe Atrial Pacing Preference™ (APP; Guidant, St Paul, MN, USA) algorithm allows the pacemaker to maintain a pacing rate slightly higher than the sinus rate. The preventive effects of APP on paroxysmal atrial fibrillation (AF) were studied in 51 patients (70±11 years). Nine patients did not complete the protocol. The pacemaker was programmed in random order to APP off and APP on at 3 different settings (ie, 8, 16 and 32 cycles) for 4 weeks each, using a cross-over design. Percentage atrial pacing was lower...

show abstract

Canadian Trial of Physiological Pacing

Cited by 176 publications

References 21 publications

Association of statin therapy and the risk of atrial fibrillation in patients with a permanent pacemaker

Association of statin therapy and the risk of atrial fibrillation in patients with a permanent pacemaker

New Insights Into the Initiation of Atrial Fibrillation

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

Contact Info

Product

Resources

About