Europace Advance Access published online on October 3, 2007
Europace, doi:10.1093/europace/eum170
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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
1 Drexel University College of Medicine, Philadelphia, PA, USA; 2 University of Utah, Salt Lake City, UT, USA; 3 Las Cruces Memorial Medical Center, Las Cruces, NM, USA; 4 Central Baptist Hospital, Lexington, KY, USA; 5 Lancaster Heart Foundation, Lancaster, PA, USA; 6 Duke University, Durham, NC, USA; 7 St Luke’s Hospital, Kansas City, MO, USA; 8 CVPH Medical Center, Plattsburgh, NY, USA; 9 St Jude Medical CRMD, Sylmar, CA, USA
Aims: Different pacing sites and various algorithms have been utilized to prevent atrial fibrillation (AF) in pacemaker recipients. However, the optimal pacing rate settings have not yet been established. In this randomized, prospective, multicentre, single-blinded, cross over study, rate-adaptive pacing at a high base rate (BR) in patients, age 60 years or above, or a history of paroxysmal AF, who underwent dual-chamber (DDD) pacemaker implantation for standard pacing indications, was evaluated for prevention of AF.
Methods and results: In the study cohort of 145 patients implanted with DDD pacemakers with a programmable rest rate (RR) feature, the BR/RR settings were sequentially but randomly adjusted as follows: 60 bpm/Off for the baseline quarter (initial 3 months) and then to either ‘A–B–C’ or ‘C–B–A’ settings (A = 70/65 bpm, B = 70/Off, C = 80/65 bpm) for the subsequent quarters each of 3 months duration. Data on automatic mode switch episodes, device diagnostics, and a questionnaire evaluating pacemaker awareness and palpitations were collected. Ninety-nine patients, mean age 77 ± 10 years, who completed the study protocol and followed for 12 months did not show significant differences in the number of mode switch episodes between any settings used. The percentage of atrial pacing was lower during baseline pacing compared to settings A, B, and C (P < 0.0001). Setting C produced a higher percentage of atrial pacing than A and B (P < 0.01). Although a higher percentage of atrial pacing correlated with a lower incidence of mode switch episodes, there was no statistically significant difference in the number of mode switch episodes between settings A, B, and C. There were no significant differences in the questionnaire scores relating to pacemaker awareness or palpitation.
Conclusion: Overdrive single-site pacing in the right atrium achieved by programming analysed settings in the present study did not reduce AF as assessed by mode switch episodes. Additionally, no change in the symptoms of arrhythmia or awareness of pacing was seen.
Key Words: Atrial fibrillation, Cardiac pacing, Atrial overdrive pacing, Dual-chamber pacemaker
* Corresponding author: Department of Cardiology, The University of Texas Houston Medical School, 6431 Fannin, MSB 1.246, Houston, TX 77030, USA. Tel: +1 713 500 6590; fax: +1 713 500 6556. E-mail address: bkantharia{at}yahoo.com
Manuscript submitted 11 March 2007. Accepted after revision 11 June 2007.
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