Combined Efficacy of Atrial Septal Lead Placement and Atrial Pacing Algorithms for Prevention of Paroxysmal Atrial Tachyarrhythmia

Luigi Padeletti; Helmut Pürerfellner; Stuart W. Adler; Theodore J. Waller; Mark Harvey; Lewis Horvitz; Reece Holbrook; Kitty Kempen; Andrew Mugglin; Douglas A. Hettrick

doi:10.1046/j.1540-8167.2003.03191.x

Combined Efficacy of Atrial Septal Lead Placement and Atrial Pacing Algorithms for Prevention of Paroxysmal Atrial Tachyarrhythmia

Luigi Padeletti, Helmut Pürerfellner, Stuart W. Adler, Theodore J. Waller, Mark Harvey, Lewis Horvitz, Reece Holbrook, Kitty Kempen, Andrew Mugglin, Douglas A. Hettrick

Biostatistics

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156 Scopus citations

Abstract

Introduction: The combined role of atrial septal lead location and atrial pacing algorithms in the prevention of atrial tachyarrhythmias (AT/AF), including both atrial fibrillation and flutter, is unknown. We tested the hypothesis that atrial prevention pacing algorithms could decrease AT/AF frequency in patients with atrial septal leads, bradycardia, and paroxysmal AT/AF. Methods and Results: A total of 298 patients (age 70 ± 10 years; 61% male) from 35 centers were implanted with a DDDRP pacing system including three AT/AF prevention pacing algorithms. Lead site was randomized at implant to right atrial septal or nonseptal. Patients were randomized 1 month postimplant to AT/AF prevention ON or OFF for 3 months and then crossed over for 3 months. Patients logged symptomatic AT/AF episodes via a manual activator. Prevention efficacy was evaluated based on intention-to-treat in 277 patients (138 septal) with complete follow-up. No changes in device-recorded AT/AF frequency or burden were observed with algorithms OFF versus ON or between patients randomized to septal versus nonseptal lead location. Analysis of other secondary outcomes revealed that AT/AF prevention pacing resulted in decreased atrial premature contractions in both the septal (1.9 [0.2-8.7] vs 3.3 [0.3-10.6] x 10³/day; P < 0.01) and nonseptal groups (0.9 [0.2-3.3] vs 1.3 [0.3-5.5] x 10³/day; P < 0.001). Patients with septal leads had fewer symptomatic AT/AF episodes ON versus OFF (1.4 ± 3.0 vs 2.5 ± 5.2/month, P = 0.01). Conclusion: The combination of three atrial prevention pacing algorithms did not decrease device classified atrial tachyarrhythmia frequency or burden during a 3-month cross-over period in bradycardic patients and septal or nonseptal atrial pacing leads. Prevention pacing was associated with decreased frequency of premature atrial contractions and with decreased symptomatic atrial tachyarrhythmia frequency in patients with atrial septal leads.

Original language	English (US)
Pages (from-to)	1189-1195
Number of pages	7
Journal	Journal of cardiovascular electrophysiology
Volume	14
Issue number	11
DOIs	https://doi.org/10.1046/j.1540-8167.2003.03191.x
State	Published - Nov 2003

Keywords

And trial
Atrial flutter
Pacing
Prevention
Tachyarrhythmia

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Padeletti, L., Pürerfellner, H., Adler, S. W., Waller, T. J., Harvey, M., Horvitz, L., Holbrook, R., Kempen, K., Mugglin, A., & Hettrick, D. A. (2003). Combined Efficacy of Atrial Septal Lead Placement and Atrial Pacing Algorithms for Prevention of Paroxysmal Atrial Tachyarrhythmia. Journal of cardiovascular electrophysiology, 14(11), 1189-1195. https://doi.org/10.1046/j.1540-8167.2003.03191.x

Padeletti, L, Pürerfellner, H, Adler, SW, Waller, TJ, Harvey, M, Horvitz, L, Holbrook, R, Kempen, K, Mugglin, A & Hettrick, DA 2003, 'Combined Efficacy of Atrial Septal Lead Placement and Atrial Pacing Algorithms for Prevention of Paroxysmal Atrial Tachyarrhythmia', Journal of cardiovascular electrophysiology, vol. 14, no. 11, pp. 1189-1195. https://doi.org/10.1046/j.1540-8167.2003.03191.x

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title = "Combined Efficacy of Atrial Septal Lead Placement and Atrial Pacing Algorithms for Prevention of Paroxysmal Atrial Tachyarrhythmia",

abstract = "Introduction: The combined role of atrial septal lead location and atrial pacing algorithms in the prevention of atrial tachyarrhythmias (AT/AF), including both atrial fibrillation and flutter, is unknown. We tested the hypothesis that atrial prevention pacing algorithms could decrease AT/AF frequency in patients with atrial septal leads, bradycardia, and paroxysmal AT/AF. Methods and Results: A total of 298 patients (age 70 ± 10 years; 61% male) from 35 centers were implanted with a DDDRP pacing system including three AT/AF prevention pacing algorithms. Lead site was randomized at implant to right atrial septal or nonseptal. Patients were randomized 1 month postimplant to AT/AF prevention ON or OFF for 3 months and then crossed over for 3 months. Patients logged symptomatic AT/AF episodes via a manual activator. Prevention efficacy was evaluated based on intention-to-treat in 277 patients (138 septal) with complete follow-up. No changes in device-recorded AT/AF frequency or burden were observed with algorithms OFF versus ON or between patients randomized to septal versus nonseptal lead location. Analysis of other secondary outcomes revealed that AT/AF prevention pacing resulted in decreased atrial premature contractions in both the septal (1.9 [0.2-8.7] vs 3.3 [0.3-10.6] x 103/day; P < 0.01) and nonseptal groups (0.9 [0.2-3.3] vs 1.3 [0.3-5.5] x 103/day; P < 0.001). Patients with septal leads had fewer symptomatic AT/AF episodes ON versus OFF (1.4 ± 3.0 vs 2.5 ± 5.2/month, P = 0.01). Conclusion: The combination of three atrial prevention pacing algorithms did not decrease device classified atrial tachyarrhythmia frequency or burden during a 3-month cross-over period in bradycardic patients and septal or nonseptal atrial pacing leads. Prevention pacing was associated with decreased frequency of premature atrial contractions and with decreased symptomatic atrial tachyarrhythmia frequency in patients with atrial septal leads.",

keywords = "And trial, Atrial flutter, Pacing, Prevention, Tachyarrhythmia",

author = "Luigi Padeletti and Helmut P{\"u}rerfellner and Adler, {Stuart W.} and Waller, {Theodore J.} and Mark Harvey and Lewis Horvitz and Reece Holbrook and Kitty Kempen and Andrew Mugglin and Hettrick, {Douglas A.}",

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AU - Padeletti, Luigi

AU - Pürerfellner, Helmut

AU - Adler, Stuart W.

AU - Waller, Theodore J.

AU - Harvey, Mark

AU - Horvitz, Lewis

AU - Holbrook, Reece

AU - Kempen, Kitty

AU - Mugglin, Andrew

AU - Hettrick, Douglas A.

PY - 2003/11

Y1 - 2003/11

N2 - Introduction: The combined role of atrial septal lead location and atrial pacing algorithms in the prevention of atrial tachyarrhythmias (AT/AF), including both atrial fibrillation and flutter, is unknown. We tested the hypothesis that atrial prevention pacing algorithms could decrease AT/AF frequency in patients with atrial septal leads, bradycardia, and paroxysmal AT/AF. Methods and Results: A total of 298 patients (age 70 ± 10 years; 61% male) from 35 centers were implanted with a DDDRP pacing system including three AT/AF prevention pacing algorithms. Lead site was randomized at implant to right atrial septal or nonseptal. Patients were randomized 1 month postimplant to AT/AF prevention ON or OFF for 3 months and then crossed over for 3 months. Patients logged symptomatic AT/AF episodes via a manual activator. Prevention efficacy was evaluated based on intention-to-treat in 277 patients (138 septal) with complete follow-up. No changes in device-recorded AT/AF frequency or burden were observed with algorithms OFF versus ON or between patients randomized to septal versus nonseptal lead location. Analysis of other secondary outcomes revealed that AT/AF prevention pacing resulted in decreased atrial premature contractions in both the septal (1.9 [0.2-8.7] vs 3.3 [0.3-10.6] x 103/day; P < 0.01) and nonseptal groups (0.9 [0.2-3.3] vs 1.3 [0.3-5.5] x 103/day; P < 0.001). Patients with septal leads had fewer symptomatic AT/AF episodes ON versus OFF (1.4 ± 3.0 vs 2.5 ± 5.2/month, P = 0.01). Conclusion: The combination of three atrial prevention pacing algorithms did not decrease device classified atrial tachyarrhythmia frequency or burden during a 3-month cross-over period in bradycardic patients and septal or nonseptal atrial pacing leads. Prevention pacing was associated with decreased frequency of premature atrial contractions and with decreased symptomatic atrial tachyarrhythmia frequency in patients with atrial septal leads.

AB - Introduction: The combined role of atrial septal lead location and atrial pacing algorithms in the prevention of atrial tachyarrhythmias (AT/AF), including both atrial fibrillation and flutter, is unknown. We tested the hypothesis that atrial prevention pacing algorithms could decrease AT/AF frequency in patients with atrial septal leads, bradycardia, and paroxysmal AT/AF. Methods and Results: A total of 298 patients (age 70 ± 10 years; 61% male) from 35 centers were implanted with a DDDRP pacing system including three AT/AF prevention pacing algorithms. Lead site was randomized at implant to right atrial septal or nonseptal. Patients were randomized 1 month postimplant to AT/AF prevention ON or OFF for 3 months and then crossed over for 3 months. Patients logged symptomatic AT/AF episodes via a manual activator. Prevention efficacy was evaluated based on intention-to-treat in 277 patients (138 septal) with complete follow-up. No changes in device-recorded AT/AF frequency or burden were observed with algorithms OFF versus ON or between patients randomized to septal versus nonseptal lead location. Analysis of other secondary outcomes revealed that AT/AF prevention pacing resulted in decreased atrial premature contractions in both the septal (1.9 [0.2-8.7] vs 3.3 [0.3-10.6] x 103/day; P < 0.01) and nonseptal groups (0.9 [0.2-3.3] vs 1.3 [0.3-5.5] x 103/day; P < 0.001). Patients with septal leads had fewer symptomatic AT/AF episodes ON versus OFF (1.4 ± 3.0 vs 2.5 ± 5.2/month, P = 0.01). Conclusion: The combination of three atrial prevention pacing algorithms did not decrease device classified atrial tachyarrhythmia frequency or burden during a 3-month cross-over period in bradycardic patients and septal or nonseptal atrial pacing leads. Prevention pacing was associated with decreased frequency of premature atrial contractions and with decreased symptomatic atrial tachyarrhythmia frequency in patients with atrial septal leads.

KW - And trial

KW - Atrial flutter

KW - Pacing

KW - Prevention

KW - Tachyarrhythmia

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Combined Efficacy of Atrial Septal Lead Placement and Atrial Pacing Algorithms for Prevention of Paroxysmal Atrial Tachyarrhythmia

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