Reactive atrial-based antitachycardia pacing therapy reduces atrial tachyarrhythmias.

George H Crossley,Steven Zweibel,Giuseppe Boriani,Luigi Padeletti,Yan Zhang,J Harrison Hudnall

doi:10.1111/pace.13696

Abstract

BackgroundReactive atrial‐based antitachycardia pacing (rATP) aims to terminate atrial tachyarrhythmia/atrial fibrillation (AT/AF) episodes when they spontaneously organize to atrial flutter or atrial tachycardia; however, its effectiveness in the real‐world has not been studied. We used a large device database (Medtronic CareLink, Medtronic, Minneapolis, MN, USA) to evaluate the effects of rATP at reducing AT/AF.MethodsPacemaker, defibrillator, and resynchronization device transmission data were analyzed. Eligible patients had device detected AT/AF during a baseline period but were not in persistent AT/AF immediately preceding first transmission. Note that 1:1 individual matching between groups was conducted using age, sex, device type, pacing mode, AT/AF, and percent ventricular pacing at baseline. Risks of AT/AF events were compared between patients with rATP‐enabled versus control patients with rATP‐disabled or not available in the device. For matched patients, AT/AF event rates at 2 years were estimated by Kaplan‐Meier method, and hazard ratios (HRs) were calculated by Cox proportional hazard models.ResultsOf 43,440 qualifying patients, 4,203 had rATP on. Matching resulted in 4,016 pairs, totaling 8,032 patients for analysis. The rATP group experienced significantly lower risks of AT/AF events lasting ≥1 day (HR 0.81), ≥7 days (HR 0.64), and ≥30 days (HR 0.56) compared to control (P < 0.0001 for all). In subgroup analysis, rATP was associated with reduced risks of AT/AF events across age, sex, device type, baseline AT/AF, and preventive atrial pacing.ConclusionsAmong real‐world patients from a large device database, rATP therapy was significantly associated with a reduced risk of AT/AF. This association was independent of whether the patient had a pacemaker, defibrillator, or resynchronization device.

Highlights

Atrial fibrillation (AF) is the most prevalent heart rhythm disorder with approximately 5.1 million lives being affected in the Unites States.[1]
Among real-world patients from a large device database, Reactive atrial-based antitachycardia pacing (rATP) therapy was significantly associated with a reduced risk of atrial fibrillation (AT/AF)
Most were from centers in the United States (42,765, 98.4%), and the rest were from centers in Australia (632, 1.5%) and New Zealand (33, 0.08%), and unknown (10, 0.02%). rATP was enabled in 4,203 (9.7%) of the patients

Summary

Introduction

Atrial fibrillation (AF) is the most prevalent heart rhythm disorder with approximately 5.1 million lives being affected in the Unites States.[1] Prevalence varies by age, with an approximate 5% increase in risk per year above the age of 652 and by sex, with 60% being male.[3] many episodes are asymptomatic, AF is associated with poor quality of life and increased risks of heart failure, dementia, stroke, and death.[4,5,6] Costs of AF to the United States healthcare system total $26 billion annually, and the incremental cost for a single patient is $8,705.7 As the disease progresses to persistent episodes and to a permanent condition, symptoms worsen, comorbidities become more prevalent, and risks of thromboembolism, acute heart failure decompensation, and death increase.[3,5]. We used a large device database (Medtronic CareLink, Medtronic, Minneapolis, MN, USA) to evaluate the effects of rATP at reducing AT/AF

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