Randomized comparison between Ramp and Burst+ atrial antitachycardia pacing therapies in patients suffering from sinus node disease and atrial fibrillation and implanted with a DDDRP device

Gulizia, Michele Massimo; Mangiameli, S; Orazi, Serafino; Chiarandà, Giacomo; Boriani, Giuseppe; Piccione, Guglielmo; DiGiovanni, Nicolò; Colletti, Andrea; Puntrello, Calogero; Butera, Gaetano; Vasco, Calogero; Vaccaro, Ignazio; Scardace, Giuseppe; Grammatico, Andrea

doi:10.1093/europace/eul055

Cited by 14 publications

(5 citation statements)

References 47 publications

(81 reference statements)

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“…7,11,13,14 In our study mean success rates with atrial ATP were slightly over 50% and no complications were recorded. However, other studies have shown that atrial ATP, either alone or combined with prevention algorithms, does not prevent or even significantly reduce arrhythmic burden.…”

Section: Discussionsupporting

confidence: 46%

“…10 In the PITAGORA trial comparing Ramp and Burst+ pacing in 176 patients, Ramp was more effective in terminating AT episodes (53.1 vs. 44.3%, p<0.001) for a cycle length of >240 ms, this advantage being explained by the theory of pacing for the termination of AT with a presumed reentry mechanism, and also because Ramp pacing delivers a larger number of differently coupled pulses within each sequence and thus has a greater chance of capturing the atrium. 11 Improved quality of life has also been shown in patients with ATP efficacy >60%. 12 Optimization of atrial ATP therapy may reduce the duration of AT episodes and contribute to the prevention of cardioembolic events.…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, anticoagulation should be maintained in patients with thromboembolic risk factors. 11 The potential benefit of ATP therapy, which is now available in various models of conventional pacemakers, needs to be demonstrated in clinical practice. The aim of this study was to assess the effectiveness of atrial ATP in reducing arrhythmic burden and to identify predictors of success for ATP algorithms, in order to optimize their use.…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of atrial antitachycardia pacing in the treatment of paroxysmal atrial fibrillation in patients with pacemakers

Silva

Pereira

Martins

2014

Revista Portuguesa de Cardiologia (English Edition)

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Introduction: The aim of this study was to assess the effectiveness of atrial antitachycardia pacing (ATP) in the conversion of atrial tachyarrhythmia episodes, and its impact in reducing arrhythmic burden. Methods: We performed a retrospective study in the pacing laboratory of a district hospital of 57 consecutive patients implanted with a dual chamber pacemaker, capable of performing atrial antitachycardia pacing, between 2005 and 2010. The patients were divided into two groups: ATP ON (n=24) and ATP OFF (n=33). The follow-up period was 15 months, with data being collected at three follow-up consultations: the first at three months after implantation, the second at nine months and the last at 15 months. In this period, there were 12 428 ATP therapies of atrial tachyarrhythmias. Results: Although there were no statistically significant differences, there was a trend in favor of the ATP ON group, the increase in arrhythmic burden being less marked in this group. The mean percentage of ventricular apical pacing was also significantly lower in this group, which was associated with a marginally significant reduction in arrhythmic burden (p=0.06). There was a significant positive correlation between changes in the percentage of ventricular pacing and changes in arrhythmic burden (r=0.417, p=0.02).ଝ Please cite this article as: Silva R, Pereira T, Martins V. Eficácia das terapias de pacing auricular antitaquicardia no tratamento da fibrilhação auricular paroxística em doentes portadores de pacemaker. Rev Port Cardiol. 2014;33:781---788.

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Section: Discussionsupporting

confidence: 46%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effectiveness of atrial antitachycardia pacing in the treatment of paroxysmal atrial fibrillation in patients with pacemakers

Silva

Pereira

Martins

2014

Revista Portuguesa de Cardiologia (English Edition)

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“…ATP programming per se has not been studied in the CHD population. In a recent analysis of successful ATP in adults without CHD, ramp pacing was determined to be more successful than double‐extrastimulus (“Burst +”) pacing and may be considered for further studies in this population to improve ATP. Additionally, it has been reported that in patients with tachy‐brady syndrome without CHD, initial ramp ATP was successful in most patients who had successful ATP .…”

Section: Discussionmentioning

confidence: 99%

Antitachycardia Pacemakers in Congenital Heart Disease

et al. 2014

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Antitachycardia pacing therapies were successful in the majority of CHD patients who had IART after implant. Patients without documented atrial tachycardia prior to implant were unlikely to require or receive successful therapy from antitachycardia pacemaker. Those patients postatrial switch procedure who had documented IART prior to implant had the highest incidence of successful antitachycardia pacing therapies. Antitachycardia pacemaker implantation is an adjunct to the management of IART in CHD patients, but may not benefit patients who have not yet demonstrated IART.

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“…6,23 While successful ATP could be observed in terminating atrial flutter or organized atrial tachycardias, it has proved difficult to interpret the results from clinical studies evaluating ATP for AF. 7,9,23 Therefore, the evidence for treating AF through pacing is limited, although these algorithms are of interest since they appear to be safe and usually add little additional cost. 8,17 Clinical studies often focus on AF frequency and burden but few of them are aimed at evaluating the effect of AF pacing on the atrial tissue.…”

Section: Introductionmentioning

confidence: 99%

Optimizing Local Capture of Atrial Fibrillation by Rapid Pacing: Study of the Influence of Tissue Dynamics

et al. 2010

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While successful termination by pacing of organized atrial tachycardias has been observed in patients, rapid pacing of AF can induce a local capture of the atrial tissue but in general no termination. The purpose of this study was to perform a systematic evaluation of the ability to capture AF by rapid pacing in a biophysical model of the atria with different dynamics in terms of conduction velocity (CV) and action potential duration (APD). Rapid pacing was applied during 30 s at five locations on the atria, for pacing cycle lengths in the range 60-110% of the mean AF cycle length (AFCL(mean)). Local AF capture could be achieved using rapid pacing at pacing sites located distal to major anatomical obstacles. Optimal pacing cycle lengths were found in the range 74-80% AFCL(mean) (capture window width: 14.6 ± 3% AFCL(mean)). An increase/decrease in CV or APD led to a significant shrinking/stretching of the capture window. Capture did not depend on AFCL, but did depend on the atrial substrate as characterized by an estimate of its wavelength, a better capture being achieved at shorter wavelengths. This model-based study suggests that a proper selection of the pacing site and cycle length can influence local capture results and that atrial tissue properties (CV and APD) are determinants of the response to rapid pacing.

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Randomized comparison between Ramp and Burst+ atrial antitachycardia pacing therapies in patients suffering from sinus node disease and atrial fibrillation and implanted with a DDDRP device

Abstract: In patients suffering from SND and AT, Ramp therapy shows higher termination efficacy than Burst+ therapy in AT episodes with ATCL >240 ms. Further studies are required to show the impact of ATP on clinical outcomes.

Cited by 14 publications

References 47 publications

Effectiveness of atrial antitachycardia pacing in the treatment of paroxysmal atrial fibrillation in patients with pacemakers

Effectiveness of atrial antitachycardia pacing in the treatment of paroxysmal atrial fibrillation in patients with pacemakers

Antitachycardia Pacemakers in Congenital Heart Disease

Optimizing Local Capture of Atrial Fibrillation by Rapid Pacing: Study of the Influence of Tissue Dynamics

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