Europace Advance Access originally published online on August 1, 2007
Europace 2007 9(9):798-804; doi:10.1093/europace/eum149
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PACING FOR ATRIAL FIBRILLATION
No evidence of automatic atrial overdrive pacing efficacy on reduction of paroxysmal atrial fibrillation
1 Department of Cardiology, St. Lucas Andreas Hospital, J.Toorpstraat 164, 1061AEAmsterdam, the Netherlands; 2 University of Utrecht, Utrecht, the Netherlands; 3 ZOL Campus St. Jan, Genk, Belgium; 4 Clinique du Sud Luxembourg, Arlon, Belgium; 5 St. Franciscus Gasthuis, Rotterdam, the Netherlands; 6 Turku University Central Hospital, Turku, Finland; 7 Amphia Hospital, Breda, the Netherlands; 8 Tartu University Hospital, Tartu, Finland; 9 North-Estonian Central Hospital, Tallinn, Estonia; 10 Tampere University Hospital, Tampere, Finland; 11 Middelheim Hospital, Antwerp, Belgium; 12 Centre Hospitalier Hutois, Huy, Belgium; 13 Queen Mary Hospital, Hong Kong, China
Aims Paroxysmal atrial fibrillation (PAF) is frequently encountered in pacemaker patients, most commonly in sick sinus syndrome. The combination of site-specific pacing in conjunction with an overdrive algorithm combined with antiarrhythmic drugs on the incidence of PAF in patients with a conventional indication for pacing is unknown.
Methods and results Patients with pacemaker indication and PAF received a DDDR-pacemaker, which included an automatic atrial overdrive (AO) algorithm. The atrial lead was implanted in either the right atrial appendage (RAA) (n = 83) or the right low-atrial septum (LAS) (n = 94). The algorithm was switched on or off in a 3 month, single blind crossover design and antiarrhythmic drugs were kept stable. A control group of 96 patients (LAS, n = 14; RAA, n = 84) without PAF served as controls to assess any proarrhythmic effect of overdrive pacing. Atrial fibrillation (AF) burden defined as cumulative time in mode switch was not reduced during automatic AO from either the RAA or from the LAS. The reduction was not effective both for AF of short (<24 h) and long (
24 h) duration. There was no atrial proarrhythmia induced by the overdrive algorithm in the control group.
Conclusions We could not demonstrate a reduction of AF burden defined as cumulative time in AF by the AO algorithm, in patients who are paced for standard indications and PAF, neither from the RAA nor from the LAS.
Key Words: Paroxysmal atrial fibrillation, Atrial fibrillation, Pacing, Alternative site pacing, Atrial overdrive algorithm
* Corresponding author. Tel: +31 20 510 8911.E-mail address: w.g.devoogt{at}planet.nl
Manuscript submitted 12 June 2006. Accepted after revision 29 June 2007.
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