Impact of atrial antitachycardia pacing and atrial pace prevention therapies on atrial fibrillation burden over long-term follow-up

Abstract

Selective atrial pacing algorithms have been developed for prevention of atrial tachycardia/atrial fibrillation (AT/AF). Although short-term studies have shown modest to minimal incremental benefit of these algorithms compared with conventional dual-chamber (DDD/R) pacing for prevention of AT/AF, the long-term effects of these algorithms are unknown. Accordingly, we compared atrial antitachycardia pacing (ATP) therapy and combined atrial ATP and atrial pace prevention (ATP + Prevention) algorithms to conventional DDD/R pacing for prevention of AT/AF over long-term follow-up. Seventy-one patients with AT/AF following pacemaker insertion were randomized to DDD/R pacing, DDD/R plus ATP pacing, or DDD/R plus ATP and prevention pacing and followed for 3 years. Atrial tachycardia/AF burden and an AF symptom scale were compared over time between groups. Atrial tachycardia/AF burden remained stable over 3 years in the DDD/R and ATP + Prevention groups. Atrial tachycardia/AF burden increased significantly over time in the ATP group. Patients not on class I or III antiarrhythmic drug therapy were more likely to experience an increase in AT/AF burden over time. Atrial ATP and atrial ATP in combination with atrial pace prevention algorithms do not suppress AT/AF over long-term follow-up compared with DDD/R pacing.