Abstract

Atrial overdrive (AO) fails to demonstrate a preventive effect on atrial fibrillation (AF). Moreover, recent data suggest that ventricular pacing may favour AF occurrence. We designed a study to evaluate the effect of combining atrial overdrive and AV delay optimization on AF incidence. Methods PAD study was a prospective randomized parallel trial. Fallback mode switch (FMS) number and duration were retrieved from pacemaker memories at 4 and 10 months after implantation (Talent DR pacemaker (ELA Medical, France)). After 4 months of follow-up (FU), patients presenting with AF (FMS number > 2 and/or FMS duration > 30 min.) were randomized in 2 groups: 1. Optimized group (OPT): AV delay optimized and dynamic AO functions activated. 2. Control group (CTRL): 156 ms rest value of AV delay and AO not activated. Results One hundred and forty-three pts completed the protocol: 56% males, age of 73±9 years, pacemaker indication: Sinus Node Dysfunction 34%, Brady-Tachy syndrome 28% and AV block 38%. Sixty-eight pts (47%) presented AF at M4. At M10, 3 pts in OPT presented persistent AF and 7 in CTRL (NS). AF number and duration were compared in the 58 pts with paroxysmal AF. Despite randomization, an unexpected higher AF duration in the OPT arm was observed at baseline (M4): View this table: Despite limitations, the PAD study suggests that AO and AV delay optimization can reduce AF duration and number with respect to standard settings. AV delay optimization should be taken into account in AF prevention in pacemaker patients.

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