FOCUS ON ATRIAL ARRHYTHMIAS
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
1 Cardiology Department, Garibaldi-Nesima Hospital, Via Palermo 636, Catania 95122, Italy; 2 Cardiology Department, Garibaldi Hospital, Catania, Italy; 3 Cardiology Department, S. Camillo de Lellis, Rieti, Italy; 4 Cardiology Department, Muscatello Hospital, Augusta, Italy; 5 Cardiology Department, S. Orsola Hospital, Bologna, Italy; 6 Cardiology Department, Civile Hospital, Ragusa, Italy; 7 Cardiology Department, Abele Aiello Hospital, Mazzara del Vallo, Italy; 8 Cardiology Department, Civili Riuniti Hospital, Sciacca, Italy; 9 Cardiology Department, S. Antonio Abate Hospital, Trapani, Italy; 10 Cardiology Department, Clinica Noto Pasqualino, Palermo, Italy; 11 Cardiology Department, Umberto I Hospital, Enna, Italy; 12 Cardiology Department, S. Giovanni di Dio Hospital, Agrigento, Italy; 13 Clinical Department, Medtronic Italia SpA, Milano, Italy
Aims Atrial tachycardia and flutter frequently occur in association with atrial fibrillation and may be treated by overdrive pacing in patients who receive pacemakers with antitachycardia pacing (ATP) capabilities. The PITAGORA trial was a multi-centre, randomized, cross-over study aimed at comparing two different ATP modes for atrial tachyarrhythmia (AT) termination in patients suffering from sinus node disease (SND).
Methods and results One hundred and seventy-six patients (72 M, age 71±9 years) received a Medtronic AT500 pacemaker. All patients were on class IC or III antiarrhythmic drugs. After a 5-month observation period, 170 patients were randomized to either Ramp or Burst+ ATP therapy; 4 months later they crossed over. One hundred and fifty-seven patients completed the 13 months of follow-up; 114 (72.6%) suffered 6088 AT episodes. In 75 patients, 1904 AT episodes were treated and 934 (49.1%) successfully terminated. The median value of individual patients' ATP efficacy was 60%. Burst+ terminated 387 out of 873 AT episodes (44%) in 58 patients. Ramp terminated 547 out of 1031 AT episodes (53%, P<0.001) in 56 patients. Ramp efficacy was significantly (P<0.01) and directly correlated with AT cycle length (ATCL), whereas Burst+ efficacy was not. Ramp showed higher (P<0.001) termination efficacy than Burst+ for ATCL >240 ms. Quality of life, as measured by the EuroQoL questionnaire, and number of symptoms significantly improved in the overall population. This improvement was significantly higher in patients with ATP efficacy >60%.
Conclusion 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.
Key Words: Antitachycardia pacing, Termination efficacy, Atrial fibrillation, AT500, Ramp, Burst+
* Corresponding author. Tel: +39 095 7598501; fax: +39 095 7120662. E-mail address: michele.gulizia{at}tin.it
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