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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