The relationship between high-frequency right ventricular pacing and paroxysmal atrial fibrillation burden

doi:10.1093/europace/eup218

Europace Advance Access originally published online on August 6, 2009
Europace 2009 11(11):1456-1461; doi:10.1093/europace/eup218

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Atrial Fibrillation and Pacing

The relationship between high-frequency right ventricular pacing and paroxysmal atrial fibrillation burden

John Silberbauer¹^,*, Rick A. Veasey¹, Nick Freemantle², Anita Arya¹, Lana Boodhoo¹ and Neil Sulke¹

¹ Cardiology Department, Eastbourne General Hospital, East Sussex NHS Trust Kings Drive, Eastbourne BN21 2UD, UK; ² Department of Clinical Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK

Aims: Right ventricular pacing increases the risk of persistent atrialfibrillation (AF) in the long term. The effects of right ventricularpacing on paroxysmal AF (PAF) are unknown. The aim was to examinethe effect of right ventricular pacing on AF burden (AFB) inpatients with symptomatic drug-resistant PAF. Pooled analysisof pacemaker-derived counters and AF diagnostic data from theAtrial Fibrillation Therapy (AFT) and Pacemaker Atrial FibrillationSuppression (PAFS) randomized anti-AF pacemaker algorithm trialswere used.

Methods and results: Five hundred and fifty-four patients from the AFT (n = 372)and PAFS (n = 182) were studied. The individual percentagesof pacing, Atrial Sense Ventricular Pace (ASVP), Atrial PaceVentricular Pace (APVP), and Atrial Pace Ventricular Sense (APVS)as well as total ventricular pacing during synchronous rhythm(VPinSR, %) were examined for an effect on AFB. Three hundredand twenty-one (AFT, age 64 ± 11, 55% male) and 79 (PAFS,age 71 ± 8, 54% male) patients had complete data foranalysis. Increased VPinSR was weakly associated with an increasedAFB (effect size—10% VPinSR increased AFB by only 0.03%)in AFT (P = 0.04) but not PAFS (P = 0.98) or the pooled analysis(P = 0.95). None of the synchronous paced modalities (ASVP,APVP, APVS) significantly increased AFB compared with sinusrhythm (Atrial Sense Ventricular Sense) (P = ns).

Conclusion: No pacing modality, atrial or ventricular, had a significanteffect on AFB. On the basis of these data, the detrimental effectof high-frequency right ventricular pacing on AFB in paced PAFpatients, unlike with persistent AF, appears to be minimal inthe short term.

Key Words: Paroxysmal atrial fibrillation, Atrial fibrillation burden, Right ventricular pacing

^* Corresponding author. Tel: +44 1323 435 869, Fax: +44 1323 435 821, Email: johnsilberbauer{at}lycos.com

Manuscript submitted 9 March 2009. Accepted after revision 19 July 2009.

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