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Europace 2005 7(3):248-254; doi:10.1016/j.eupc.2005.01.004
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© 2005 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.

Comparison of immediate and delayed automatic antitachycardia pacing for the termination of atrial tachyarrhythmias

Dirk Vollmann*, Eveline Kollet, Lars Lüthje, Sabine Busse and Christina Unterberg

Department of Cardiology and Pneumology, Georg-August-University Göttingen, Germany

AIMS: Automatic atrial antitachycardia pacing (ATP) can terminate atrial tachyarrhythmias (ATs) in patients with an implanted device. We investigated if the programmable delay between AT onset and ATP influences therapy efficacy.

METHODS: Patients with intermittent ATs and an implanted DDDRP pacemaker were randomized to receive ATP either immediately or 30 min after AT detection. After four months stored data were interrogated, AT-related symptoms were assessed, and patients crossed over to the alternative treatment arm for another four months. Stored atrial electrograms were analyzed for degree of AT organization and ATP success.

RESULTS: In 22 patients (64% male; 72 ± 7 years), ATP success rates were higher during immediate than during delayed ATP (device classification: 59 ± 7% vs. 22 ± 5%, P < 0.01; manual analysis: 36 ± 6% vs. 12 ± 5%, P < 0.01). Higher efficacy of immediate ATP was associated with a larger proportion of organized (Type I) AT prior to therapy (71% vs. 44% during delayed ATP). No difference was found in total AT numbers and duration, AT burden or related symptoms.

CONCLUSIONS: The programmable delay between arrhythmia onset and therapy delivery significantly influences the success-rate of ATP. However, a higher efficacy of immediate compared with delayed ATP does not translate into a reduction of AT burden or related symptoms.

Key Words: atrial tachyarrhythmias, atrial fibrillation, atrial pacing, antitachycardia pacing, pacing algorithm

*Corresponding author. Herzzentrum, Abteilung Kardiologie und Pneumologie, Klinikum der Georg-August Universität Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany. Tel.: +49 551 39 9625; fax: +49 551 39 9628. E-mail address: dirkvollmann2000{at}aol.com (D. Vollmann).


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