© 2001 by European Society of Cardiology
Atrial arrhythmia suppression by atrial overdrive pacing: pacemaker Holter assessment
Cardiothoracic Centre, Guy's and St Thomas' Hospitals London, U.K
The purpose of this study was to assess the efficacy of overdrive, single-site right atrial appendage pacing to reduce the burden of atrial fibrillation (AF) when compared with a standard lower rate limit of 60 bpm. This was verified by using the pacemaker’s Holter.
Eighteen subjects with a pre-implant history of paroxysmal AF and implanted DDDR mode-switching pacemakers were recruited. The pacemaker lower rate limit was programmed in random order to 60, 75 or 90 bpm for three 2-month periods and the amount of AF quantified. In addition, the exercise tolerance (ET), general well being (GWB), functional capacity (FC) and specific symptom prevalence (SSP) were assessed.
The main finding of the study was that when ranked according to the amount of AF, there was no significant difference in the amount of AF according to the pacing rate. Six patients failed to tolerate pacing at 90 bpm. There were no differences in the ET, GWB, FC and SSP scores.
It is concluded that those clinicians that manage patients with paroxysmal AF and desire arrhythmia suppression should now consider alternative pacing strategies.
Key Words: Atrial fibrillation, pacing, Holter
[1] Wijffels MCEF, Kicrhhof CJHJ, Dorland R, Allessie MA. Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats. Circulation 1995; 92: 1954–1968.
[2] Wijffels MCEF, Kicrhhof CJHJ, Dorland R, Powers J, Allessie MA. Electrical remodelling due to atrial fibrillation in chronically instrumented conscious goats. Circulation 1997; 96: 3710–3720.
[3] Luck JC and Engel TR. Dispersion of atrial refractoriness in patients with sinus node dysfunction. Circulation 1979; 60: 404–412.
[4] Murgatroyd FD, Nitzsche R, Slade AKB, et al. A new pacing algorithm for overdrive suppression of atrial fibrillation. Pacing Clin Electrophysiol 1994; 17: 1966–1973.[CrossRef][Medline]
[5] Saksena S, Prakash A, Hill M, et al. Prevention of atrial fibrillation with chronic dual-site right atrial pacing. J Am Coll Cardiol 1996; 28: 687–694.[Abstract]
[6] Daubert C, Gras D, Leclercq C, Baisset JM, Pavin D, Mabo P. Biatrial synchronous pacing: a new therapeutic approach to prevent refractory atrial tachyarrhythmias. J Am Coll Cardiol 1995; 25: 230A (Abstract).
[7] Prakash A, Saksena S, Hill M, et al. Acute effects of dualsite atrial pacing in patients with spontaneous and inducible atrial flutter and fibrillation. J Am Coll Cardiol 1997; 29: 1007–1014.[Abstract]
[8] Daubert C, Gras D, Baisset JM, Pavin D, Mabo P. Biatrial synchronous pacing: a new approach for prevention of drug refractory atrial flutter. Circulation 1995; 92: I–532.
[9] Gillis AM, Wyse G, Connolly SJ, et al. Atrial pacing periablation for prevention of paroxysmal atrial fibrillation. Circulation 1999; 99: 2558.
[10] Ricci A, Puglisi A, Neja CP, et al. Consistent atrial pacing: can this new algorithm suppress recurrent atrial fibrillation? Pacing Clin Electrophysiol 1997; 20: 1227.
[11] Kamalvand K, Tan K, Kotsakis A, Bucknall C, Sulke N. Is mode switching beneficial? A randomized study in patients with paroxysmal atrial tachyarrhythmias. J Am Coll Cardiol 1997; 30: 496–504.[Abstract]
[12] Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio measures for chronic and experimental pain. Pain 1983; 17: 45–56.[CrossRef][Web of Science][Medline]
[13] Goldman L, Hashimoto B, Cook F, Loscalzo A. Comparative reproducibility and validity of systems for assessing cardiovascular functional class: advantages of a new specific activity scale. Circulation 1981; 64: 1227–1234.[Medline]
[14] Ritter P. Does the 24-hour Holter remain the gold standard technique to assess the efficacy of anti-arrhythmic therapies in the brady-tachy syndrome? Pacing Clin Electrophysiol 1996; 19: 637 (Abstract).
[15] Limousin M, Geroux L, Caussin C, et al. Reliability of memorized data in an implanted pacemaker, and automation of the analysis: initial results on 59 implanted patients. Pacing Clin Electrophysiol 1996; 19: 637 (Abstract).
[16] Hesselson AB, Parsonnet V, Bernstein AD, Bonavita GJ. Deleterious effects of long-term single-chamber ventricular pacing in patients with sick sinus syndrome: the hidden benefits of dual-chamber pacing. J Am Coll Cardiol 1992; 19: 1542–1549.[Abstract]
[17] Feuer JM, Shandling AH, Messenger JC. Influence of cardiac pacing mode on the long-term development of atrial fibrillation. Am J Cardiol 1989; 64: 1376–1379.[CrossRef][Web of Science][Medline]
[18] Reimold SC, Lamas GA, Cantillon CO, Antman EM. Risk factors for the development of recurrent atrial fibrillation: Role of pacing and clinical variables. Am Heart J 1995; 129: 1127–1132.[CrossRef][Web of Science][Medline]
[19] Andersen HR, Thuesen L, Bagger JP, Vesterlund T, Thomsen PEB. Prospective randomised trial of atrial versus ventricular pacing in sick-sinus syndrome. Lancet 1994; 344: 1523–1528.[CrossRef][Web of Science][Medline]
[20] Lamas GA, Orav JE, Stambler BS, et al. Quality of life and clinical outcomes in elderly patients treated with ventricular pacing as compared with dual chamber pacing. N Eng J Med 1998; 338: 1097–1104.
[21] Connolly SJ, Kerr CD, Gent M, et al. Effects of physiologic pacing versus ventricular pacing on the risk of stroke and death due to cardiovascular causes. N Eng J Med 2000; 342: 1385–1391.
[22] Garrigue S, Cazeau S, Gencel L, Jais P, Haissaguerre M, Clementy J. Prevention of atrial arrhythmias during DDD pacing by atrial overdriving. Pacing Clin Electrophysiol 1997; 20: 1092 (Abstract).
[23] Coumel P, Friocourt P, Mugica J, Attuel P, LeClercq J-F. Long-term prevention of vagal atrial arrhythmias by atrial pacing at 90/minute: experience with 6 cases. Pacing Clin Electrophysiol 1983; 6: 552–560.[CrossRef][Medline]
[24] Papageorgiou P, Anselme F, Kirchhof CJHJ, et al. Coronary sinus pacing prevents induction of atrial fibrillation. Circulation 1997; 96: 1893–1898.
[25] Papageorgiou P, Monahan K, Boyle NG, et al. Site-dependant intra-atrial conduction delay. Relation to initiation of atrial fibrillation. Circulation 1996; 94: 384–389.
[26] Prakash A, Delfaut P, Krol RB, Saksena S. Regional right and left atrial activation patterns during single- and dual-site atrial pacing in patients with atrial fibrillation. Am J Cardiol 1998; 82: 1197–1204.[CrossRef][Web of Science][Medline]
[27] Page RL, Wilkinson WE, Clair WK, McCarthy EA, Pritchett ELC. Asymptomatic arrhythmias in patients with symptomatic paroxysmal atrial fibrillation and paroxysmal supraventricular tachycardia. Circulation 1994; 89: 224–227.
[28] Munsif AN, Prakash A, Kroll R, Mathew P, Lewis C, Saksena S. Crista terminalis, atrial septal and coronary sinus activation during single and dual site atrial pacing. Pacing Clin Electrophysiol 1996; 19: 578 (Abstract).
[29] Spencer WH, Zhu DWX, Markowitz T, Badruddin SM, Zoghbi WA. Atrial septal pacing: A method for pacing both atria simultaneously. Pacing Clin Electrophysiol 1997; 20: 2739–2745.[CrossRef][Medline]
[30] Cazeau S, Garrigue S, Ritter P, et al. DDD pacing and Atrial arrhythmia in Sinus node dysfunction: long-term followup using the Holter function of the device. Pacing Clin Electrophysiol 1996; 19: 637 (Abstract).
[31] Menozzi C, Brignole M, Moracchini PV, et al. Intrapatient comparison between chronic VVIR and DDD pacing in patients affected by high degree AV block without heart failure. Pacing Clin Electrophysiol 1990; 13: 1816–1822.[Medline]
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  A.J. Camm, N. Sulke, N. Edvardsson, P. Ritter, B.A. Albers, J.H. Ruiter, T. Lewalter, P.A. Capucci, E. Hoffmann, and on behalf of the AFTherapy investigators Conventional and dedicated atrial overdrive pacing for the prevention of paroxysmal atrial fibrillation: the AFTherapy study Europace, December 1, 2007; 9(12): 1110 - 1118. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. W. Israel What is the role of the pacing rate in the prevention of atrial tachyarrhythmias? Europace, November 1, 2007; 9(11): 999 - 1001. [Full Text] [PDF]
|
|
|
|
|
|
B. K. Kantharia, R. A. Freedman, D. Hoekenga, G. Tomassoni, S. Worley, R. Sorrentino, D. Steinhaus, J. M. Wolkowicz, Z. A. Syed, and and the AOP Study Investigators Increased base rate of atrial pacing for prevention of atrial fibrillation after implantation of a dual-chamber pacemaker: insights from the Atrial Overdrive Pacing Study Europace, November 1, 2007; 9(11): 1024 - 1030. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. D. Carlson, J. Ip, J. Messenger, S. Beau, S. Kalbfleisch, P. Gervais, D. A. Cameron, A. Duran, J. Val-Mejias, J. Mackall, et al. A new pacemaker algorithm for the treatment of atrial fibrillation: Results of the Atrial Dynamic Overdrive Pacing Trial (ADOPT) J. Am. Coll. Cardiol., August 20, 2003; 42(4): 627 - 633. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C.-P. Lau Pacing for atrial fibrillation Heart, January 1, 2003; 89(1): 106 - 112. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||