Atrial overdrive pacing and incidence of heart failure-related adverse events in permanently paced patients
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Atrial overdrive pacing algorithms may be effective in preventing or suppressing atrial fibrillation (AF). However, the maintenance of a heart rate incessantly faster than spontaneous could induce left ventricular (LV) dysfunction and promote heart failure (HF) on the long term.
This post hoc analysis examined the effects of a new overdrive algorithm on the incidence of HF-related adverse events in 411 patients enrolled in the ADOPT-A trial.
Materials and methods
The AF Suppression™ algorithm was randomly programmed ON in 209 patients (treatment group) versus OFF in 202 patients (control group). The incidence of HF-related adverse events and HF-related deaths over a 6-month follow-up was compared between the two groups. Patients with versus without HF-related clinical events were also compared to each other within each group.
There were eight HF-related adverse clinical events (3.8%) in the treatment group and 11 (5.4%) in the control group, including four HF-related deaths (1.9 vs. 2.0%) in each group during follow-up. Baseline NYHA functional class in patients with versus without HF-related adverse events was 1.4 ± 0.5 versus 1.5 ± 0.7 in the control, and 1.5 ± 0.8 versus 1.5 ± 0.6 in the treatment group. LV ejection fraction (EF) was 49 ± 7% in patients with, versus 57 ± 12% in patients without HF-related adverse events, in the control group, and 43 ± 14% in patients with, versus 56 ± 13% in patients without HF-related adverse events, in the treatment group. LVEF was lowest and similar in both groups among patients who died from HF (35 ± 10% in the control and 38 ± 27% in the treatment group).
In ADOPT-A, HF-related clinical events and deaths were related to LV dysfunction and not to atrial pacing overdriven by the AF suppression algorithm.
KeywordsAtrial pacing Overdrive pacing Overdrive pacing algorithm Atrial fibrillation Heart failure
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- 1.Go, A. S., Hylek, E. M., Phillips, K. A., Chang, Y., Henault, L. E., Selby, J. V., et al. (2001). Prevalence of diagnosed atrial fibrillation in adults: National implications for rhythm management and stroke prevention: The Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. Journal of the American Medical Association, 285, 2370–2375, Medline. DOI 10.1001/jama.285.18.2370 PubMedCrossRefGoogle Scholar
- 3.Cazeau, S., Leclercq, C., Lavergne, T., Walker, S., Varma, C., Linde, C., et al. (2001). Multisite Stimulation in Cardiomyopathies (MUSTIC) Study investigators. Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. The New England Journal of Medicine, 344, 873–880, Medline. DOI 10.1056/NEJM200103223441202 PubMedCrossRefGoogle Scholar
- 4.Abraham, W. T., Fischer, W. G., Smith, A. L., Delurgio, D. B., Leon, A. R., Loh, E., et al. (2002). MIRACLE study group. Multicenter insync randomized clinical evaluation: Cardiac resynchronization in chronic heart failure. The New England Journal of Medicine, 346, 1845–1853, Medline. DOI 10.1056/NEJMoa013168 PubMedCrossRefGoogle Scholar
- 7.Wyse, D. G., Waldo, A. L., DiMarco, J. P., Domanski, M. J., Rosenberg, Y., Schron, E. B., et al. (2002). Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Investigators: A comparison of rate control and rhythm control in patients with atrial fibrillation. The New England Journal of Medicine, 347, 1825–1833, Medline.PubMedCrossRefGoogle Scholar
- 9.Lamas, G. A., Lee, K., Sweeney, M., Silverman, R., Leon, A., Yee, R., et al. (2002). Mode selection trial in sinus–node dysfunction. Ventricular pacing or dual-chamber pacing for sinus-node dysfunction. The New England Journal of Medicine, 346, 1854–1862, Medline. DOI 10.1056/NEJMoa013040 PubMedCrossRefGoogle Scholar
- 10.Carlson, M. D., Ip, J., Messenger, J., Beau, S., Kalbfleischer, S., Gervas, P., et al. (2003). Atrial Dynamic Overdrive Pacing Trial (ADOPT) Investigators. A new pacemaker algorithm for the treatment of atrial fibrillation: Results of the Atrial Dynamic Overdrive Pacing Trial (ADOPT). Journal of the American College of Cardiology, 42, 627–633, Medline. DOI 10.1016/S0735-1097(03)00780-0 PubMedCrossRefGoogle Scholar
- 11.Naccarelli, G. V., Hynes, B. J., Wolbrette, D. L., Bhatta, L., Khan, M., Samii, S., et al. (2003). Atrial fibrillation in heart failure: Prognostic significance and management. Journal of Cardiovascular Electrophysiology, 14(Suppl), S281–S286, Medline. DOI 10.1046/j.1540-8167.2003.90404.x PubMedCrossRefGoogle Scholar
- 12.Schuchert, A., Ali Aydin, M., Meinertz, T. (2002). Lower sinus rate after initiation of left ventricular pacing in patients with left bundle branch block and advanced heart failure. Journal of the American College of Cardiology, 39(Suppl.), A-159. Abstract.Google Scholar
- 13.Adamson, P. B., Smith, A. L., Abraham, W. T., Kleckner, K. J., Stadler, R. W., Shih, A., et al. (2004). InSync III Model 8042 and Attain OTW Lead Model 4193 Clinical Trial Investigators. Continuous autonomic assessment in patients with symptomatic heart failure: prognostic value of heart rate variability measured by an implanted cardiac resynchronization device. Circulation, 110, 2389–2394, Medline. DOI 10.1161/01.CIR.0000139841.42454.78 PubMedCrossRefGoogle Scholar
- 16.Saksena, S., Prakash, A., Ziegler, P., Hummel, J. P., Freedman, P., Plumb, P., et al. (2002). DAPPAF Investigators. Improved suppression of recurrent atrial fibrillation with dual-site right atrial pacing and antiarrhythmic drug therapy. Journal of the American College of Cardiology, 40, 1140–1150, Medline. DOI 10.1016/S0735-1097(02)02068-5 PubMedCrossRefGoogle Scholar
- 17.Wiberg, S., Lönnerholm, S., Jensen, S. M., Blomström, P., Ringqvist, I., Blomström-Lundqvist, C. (2003). Effect of right atrial overdrive pacing in the prevention of symptomatic paroxysmal atrial fibrillation: A multicenter randomized study, the PAF-PACE study. Pacing and Clinical Electrophysiology, 26, 1841–1848, Medline. DOI 10.1046/j.1460-9592.2003.t01-1-00278.x PubMedCrossRefGoogle Scholar
- 18.Ricci, R., Santini, M., Puglisi, A., Azzolini, P., Capucci, A., Pignalberi, C., et al. (2001). Impact of consistent atrial pacing algorithm on premature atrial complexe number and paroxysmal atrial fibrillation recurrences in brady-tachy syndrome: A randomized prospective cross over study. Journal of Interventional Cardiac Electrophysiology, 5, 33–44 Medline, DOI 10.1023/A:1009801706928 PubMedCrossRefGoogle Scholar
- 19.Padeletti, L, Pürerfellner, H, Adler, S. W., Waller, T. J., Harvey, M., Horvitz, L., et al. (2003). Worldwide ASPECT Investigators. Combined efficacy of atrial septal lead placement and atrial pacing algorithms for prevention of paroxysmal atrial tachyarrhythmia. Journal of Cardiovascular Diagnosis and Procedures, 14, 1189–1195, Medline. DOI 10.1046/j.1540-8167.2003.03191.x Google Scholar
- 20.Lee, M. A., Weachter, R., Pollak, S., Kremers, M. S., Naik, A. M., Siverman, R., et al. (2003). ATTEST Investigators. The effect of atrial pacing therapies on atrial tachyarrhythmia burden and frequency: results of a randomized trial in patients with bradycardia and atrial tachyarrhythmias. Journal of the American College of Cardiology, 41, 1926–1932 Medline. DOI 10.1016/S0735-1097(03)00426-1 PubMedCrossRefGoogle Scholar
- 21.Blanc, J. J., De Roy, L., Mansourati, J., Poezevers, Y., Marcon, J. L., Schoels, W., et al. (2004). PIPAF Investigators. Atrial pacing for prevention of atrial fibrillation: Assessment of simultaneously implemented algorithms. Europace, 6, 371–379, Medline. DOI 10.1016/j.eupc.2004.05.002 PubMedCrossRefGoogle Scholar
- 22.Carlsson, J., Miketic, S., Windeler, J., Cunco, A., Haun, S., Micus, S., et al. (2003). STAF investigators. randomized trial of rate-control versus rhythm-control in persistent atrial fibrillation: The Strategies of Treatment of Atrial Fibrillation (STAF) study. Journal of the American College of Cardiology, 41, 1690–1696, Medline. DOI 10.1016/S0735-1097(03)00332-2 PubMedCrossRefGoogle Scholar
- 23.Wilkoff, B. L., Cook, J. R., Epstein, A. E., Greene, H. L., Hallstrom, A. P., Hsin, H., et al. (2002). Dual chamber and VVI implantable defibrillator trial investigators. Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: The Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. Journal of the American Medical Association, 288, 3115–3123, Medline. DOI 10.1001/jama.288.24.3115 PubMedCrossRefGoogle Scholar
- 24.Sweeney, M. O., Hellkamp, A. S., Ellenbogen, K. A., Greenspon, A. J., Freedman, R. A., Lee, K. L., et al. (2003). Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation, 107, 2932–2937, Medline. DOI 10.1161/01.CIR.0000072769.17295.B1 PubMedCrossRefGoogle Scholar