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Europace 2004 6(5):371-379; doi:10.1016/j.eupc.2004.05.002
© 2004 by European Society of Cardiology
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Atrial pacing for prevention of atrial fibrillation: assessment of simultaneously implemented algorithms

Jean-Jacques Blanca, Luc De Royb, Jacques Mansouratia, Yann Poezevarac,*, Jean-Louis Marcond, Wolfgang Schoelse, Françoise Hidden-Lucetf, Claude Barnayg for the PIPAF investigators 1

aCardiology Department, Brest University Hospital Brest, France; bCardiology Department, UCL Mont-Godinne Namur, Belgium; cEla Medical, Le Plessis-Robinson France; dCardiology Department, Annonay Hospital Annonay, France; eCardiology Department, Universitätsklinikum Heidelberg, Germany; fCardiology Department, La Pitié-Salpétrière Hospital Paris, France; gCardiology Department, General Hospital Aix-En-Provence, France

AIMS: Several preliminary studies indicated that right atrial pacing could prevent atrial tachyarrhythmias (ATA). We sought to compare the safety and the efficacy of atrial-based pacing supplemented by dedicated combined algorithms with conventional atrial pacing in the prevention of ATA.

METHODS: Fifty-five patients with a history of recurrent paroxysmal ATA implanted with a dual-chamber pacemaker were studied during two randomized cross-over pacing periods (conventional DDD and DDD with ATA prevention algorithms) of 6 months duration. The primary endpoint was the burden of ATA episodes recorded by the device mode switch algorithm.

RESULTS: The cross-over analysis did not demonstrate any significant difference between the two pacing modes: 254±533 h of ATA during the control period versus 238±518 h during the ATA prevention period. Analysis of a subgroup of patients found that those with the lower percentage of ventricular pacing benefited from ATA prevention algorithms (120±182 h versus 225±350 h during the control period; P<0.04).

CONCLUSION: When compared with DDD pacing at 70 bpm, ATA prevention algorithms have not demonstrated significant efficacy. However, a subgroup of patients with preserved native AV conduction (low percentage of ventricular pacing) responded to ATA prevention algorithms.

Key Words: atrial fibrillation, right atrial pacing, prevention algorithms

*Corresponding author. Cardiology Department, Hôpital de la Cavale Blanche, Bld Tanguy Prigent, 29609 Brest, France. Tel.: +33-(0)2-98-34-73-92; fax: +33-(0)2-98-34-78-03. E-mail address: jean-jacques.blanc{at}chu-brest.fr (Y. Poezevara).


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