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Atrial overdrive pacing and incidence of heart failure-related adverse events in permanently paced patients

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

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.

Objective

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.

Results

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).

Conclusions

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.

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Author information

Authors and Affiliations

  1. Medical Clinic, Friedrich-Ebert-Hospital, Friesenstr. 11, D 24531, Neumünster, Germany

    Andreas Schuchert

  2. Department of Medicine, Case Western Reserve University Medical School and University Hospitals of Cleveland, Cleveland, OH, USA

    Mark Carlson & Judith Mackall

  3. Thoracic Cardiovascular Institute, Lansing, MI, USA

    John Ip

  4. Long Beach Memorial Medical Center, Long Beach, CA, USA

    John Messenger

  5. Arkansas Heart Hospital, Little Rock, AR, USA

    Scott Beau

  6. Mid Ohio Cardiology, Columbus, OH, USA

    Steven Kalbfleisch

  7. Hospital St. Joseph, Trois-Rivieres, Canada

    Pierre Gervais

  8. Toronto General Hospital, Toronto, Canada

    Douglas A. Cameron

  9. Orlando Heart Center, Orlando, FL, USA

    Aurelio Duran

  10. St. Francis Hospital, Wichita, KS, USA

    Jesus Val-Mejias

  11. Medical University of South Carolina, Charleston, SC, USA

    Michael Gold

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for the ADOPT Investigators

Corresponding author

Correspondence to Andreas Schuchert.

Additional information

This study was sponsored by St Jude Medical.

The following investigators and institutions participated in ADOPT A: Islam Bolad MD, Harefield Hospital, Middlesex, United Kingdom; Gabriel Breur MD, Palm Beach Gardens Medical Center, Palm Beach Gardens, Florida; Hugh Calkins MD, Johns Hopkins Hospital, Baltimore, Maryland; Luis Constantin MD, Lehigh Valley Hospital, Allentown, Pennsylvania; Paul Dorian MD, St. Michael’s, Toronto, Canada; Chris Fellows MD, Virginia Mason Clinic, Seattle, Washington; Michael Gammage MD, Queen Elizabeth Hospital, Birmingham, United Kingdom; Eli Gang MD, Cardiovascular Medical Group of Southern California, Beverly Hills, California; Michael Gold MD, University of Maryland, Baltimore, Maryland; Yisachar Greenberg MD, Maimonides Medical Center, Brooklyn, New York; Steven Greer, Arkansas Cardiology Clinic, Little Rock, Arkansas; Sajad Gulamhusein MD, Capital Health, Edmonton, Canada; Mark Harvey MD, Foundation for Cardiovascular Research, Oklahoma City, Oklahoma; Steven Klein MD, Moses Cone Memorial Hospital, Greensboro, North Carolina; Ching Lau MD, Sunnybrook Health Science Center, Toronto, Canada; Richard Leather MD, Victoria Heart Institute, Victoria, Canada; Charles Love MD, Ohio State University Medical Center, Columbus, Ohio; John Mandrola MD, Baptist Hospital East, Louisville, Kentucky; Frank McGrew III MD, Stern Cardiovascular Center, Memphis, Tennessee; John McKenzie III MD, Heart Institute of Glendale, Glendale, California; Pascal Patrick McKeown MD, Royal Victoria Hospital, Belfast, North Ireland; Stephen Prater MD, Atlanta Cardiology Group, Atlanta, Georgia; Russell Reeves MD, Cardiovascular Associates, Birmingham, Alabama; Mark Rosenthal MD, Abington Memorial Hospital, Abington, Pennsylvania; Anthony Tang MD, University of Ottawa Heart Institute, Ottawa, Canada; Bernard Thibault MD, Montreal Heart Institute, Montreal, Canada; Anthony Turi MD, St. Peter’s Hospital, Albany, New York; Mark Wathen MD, Vanderbilt University Medical Center, Nashville, Tennessee; Steve Winters MD, Morristown Memorial, Morristown, New Jersey; Seth Worley MD, Lancaster Heart Group, Lancaster, Pennsylvania.

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Schuchert, A., Carlson, M., Ip, J. et al. Atrial overdrive pacing and incidence of heart failure-related adverse events in permanently paced patients. J Interv Card Electrophysiol 19, 55–60 (2007). https://doi.org/10.1007/s10840-007-9130-0

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  • DOI: https://doi.org/10.1007/s10840-007-9130-0

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