Efficacy and tolerability of continuous overdrive atrial pacing in atrial fibrillation

Abstract

Overdrive right atrial pacing has been used to prevent atrial fibrillation, but its efficacy in atrial fibrillation prevention and the patient tolerability and quality of life during high rate pacing remain uncertain. The objective of this study was to test the effects of a consistent atrial pacing algorithm that automatically paced the atrium at 30 ms shorter than the sinus P-P interval for atrial fibrillation prevention. Fifteen patients with sick sinus syndrome implanted with a Thera DR (model 7940 or 7960, Medtronic Inc.) were randomly programmed to rate adaptive dual chamber pacing (DDDR) or DDDR + consistent atrial pacing mode, each for an 8-week study period. The efficacy of consistent atrial pacing was assessed by the number of automatic mode switching and the number of premature atrial complexes. Symptoms and quality of life were assessed by the SF-36 quality of life questionnaire and an atrial fibrillation symptom checklist. The percentage of atrial pacing increased from 57 +/- 32% to 86 +/- 28%. Overall, there was no significant difference in the number of automatic mode switching episodes between DDDR and DDDR + consistent atrial pacing (47 +/- 90 vs 42 +/- 87, P > 0.05), but a significant reduction in premature atrial complexes by 74.7% (P < 0.001). There was no undue increase in atrial rate by the DDDR + consistent atrial pacing mode versus DDDR (63 +/- 13 vs 70 +/- 7 bpm). There was no significant difference in quality of life scores and symptom severity on frequency between the two modes of pacing, but a trend towards a lower frequency of symptoms in the DDDR + consistent atrial pacing mode compared with baseline (29.5 +/- 10.2 vs 25.1 +/- 9.7, P = 0.07). An algorithm that provides consistent atrial overdrive pacing can suppress atrial fibrillation triggering premature atrial complexes without the need to increase the overall atrial rate compared with conventional pacing. The algorithm appears to be well-tolerated, but further studies are needed to address the clinical impact of this atrial fibrillation prevention algorithm.

Reducing atrial tachycardia and atrial fibrillation episodes with a prevention and treatment device and tailored treatment

“…Another limitation is the fact that several previously examined algorithms [11,13] where used at the same time, which made it impossible to examine the contribution of a single prevention or treatment algorithm to the results obtained. The still widely used routine localization of atrial and ventricular leads were used to eliminate another possible influence on AT.…”

Implanted Devices and Atrial Fibrillation

“…In general, mean heart rate is not significantly increased when these algorithms are working, and are well tolerated by the patients [36].…”

Device treatment of atrial tachycardia—minor additional effect of repeating pacing sequences

“…Dynamic atrial overdrive during short-term follow-up (FU) has shown a reduction in atrial arrhythmias, and demonstrating the feasibility and tolerability of the algorithm [5][6][7]. Overdrive suppression of atrial premature complexes which prevents postextrasystolic pauses reducing atrial ectopic activity, may also reduce atrial arrhythmias [8].…”