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Europace Advance Access published online on February 1, 2008
Europace, doi:10.1093/europace/eum301
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Right atrial preventive and antitachycardia pacing for prevention of paroxysmal atrial fibrillation in patients without bradycardia: a randomized study

Martin E.W. Hemels1, Jaap H. Ruiter2, G. Peter Molhoek3, Nic J.G.M. Veeger4, Ans C.P. Wiesfeld1, Adelita V. Ranchor5, Marcel van Trigt6, Art Pilmeyer6, Isabelle C. Van Gelder for The Features in AT500TM study; Chances for patients with Episodes of atrial Tachyarrhythmia without bradycardia indication for pacing (FACET) investigators1,*

1 Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands; 2 Medical Center Alkmaar, Alkmaar, The Netherlands; 3 Medisch Spectrum Twente, Enschede, The Netherlands; 4 Trial Coordination Center, Groningen, The Netherlands; 5 Northern Center for Health Care Research, University of Groningen, Groningen, The Netherlands; 6 Medtronic Bakken Research Center, Maastricht, The Netherlands

Aims: To investigate the efficacy of preventive and antitachycardia pacing (ATP) in patients with symptomatic paroxysmal atrial fibrillation (AF) without bradyarrhythmias.

Methods and results: In this randomized cross-over pilot study, we randomized 38 symptomatic paroxysmal AF patients ‘without' bradyarrhythmias to atrial pacing lower rate 70 ppm and prevention and ATP therapies ON or to atrial pacing lower rate 34 ppm and prevention and ATP therapies OFF during 12 weeks with a 4 week washout period in between. The atrial lead was preferably placed in the inter-atrial septum. Antiarrhythmic drugs were continued during the study. Primary endpoint was AF burden. Mean age was 62 ± 9 years and 27 (71%) patients had lone AF. Septal lead placement was accomplished in 26 (68%) patients. During the treatment ON, there was a trend for AF burden reduction [from median 3.3% (1.0–15.2) to 2.4% (0.2–12.2), P = 0.06, reduction 27%]. If septal lead placement was accomplished, AF burden reduction was statistically significant [44% reduction, from median 2.5% (1.0–8.0) to 1.4% (0.2–8.4), P = 0.03]. Quality of life and symptoms did not change, also not in the septal group.

Conclusion: A hybrid therapy of preventive and ATP pacing and antiarrhythmic drugs may significantly reduce but not abolish AF burden if septal pacing is realized.

Key Words: Atrial fibrillation, Atrial pacing, Antiarrhythmic drugs, Hybrid therapy, Rhythm control

* Corresponding author.Tel: +31 50 361 1327; fax: +31 50 361 4391. E-mail address: i.c.van.gelder{at}thorax.umcg.nl

Manuscript submitted 1 September 2007. Accepted after revision 19 December 2007.


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