Skip Navigation

This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Disclaimer
Right arrow Request Permissions
Google Scholar
Right arrow Articles by Disertori, M.
Right arrow Articles by Vimercati, M.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Disertori, M.
Right arrow Articles by Vimercati, M.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?


Antitachycardia pacing therapies to terminate atrial tachyarrhythmias: the AT500 Italian Registry

M. Disertori*,1, L. Padeletti2, M. Santini3, P. Dini4, M. Gasparini5, G. Inama6, M. Botto7, G. Boriani8, A. Capucci9, R. Ricci3, L. Gramegna1, M. Del Greco1, A. Grammaticol10 and M. Vimercati10

a S. Chiara Hospital, Trento, Italy
b Careggi Hospital, Florence, Italy
c S. Filippo Neri Hospital, Rome, Italy
d S. Camillo Hospital, Rome, Italy
e Humanitas Hospital, Rozzano, Italy
f Maggiore Hospital, Crema, Italy
g S. Anna Hospital, Como, Italy
h S. Orsola Hospital, Bologna, Italy
i Civile Hospital, Piacenza, Italy
j Medtronic, Milan, Italy

* Correspondence: Dr Marcello Disertori, Divisione di Cardiologia, Ospedale S. Chiara, 38100 Trento, Italy.

AT500 Italian Registry investigators

Abstract

Background Antitachycardia pacing (ATP) therapies may have a role to play in treating paroxysmal atrial tachyarrythmias. The Medtronic AT500 is a new DDDRP pacemaker providing automatic ATP therapies and prevention algorithms.

Method A total of 131 patients (age 71 ± 9 years, 71 male and 60 female) were enrolled in the AT500 Italian Registry after receiving the device. After implant, diagnostic features were enabled. They classify arrhythmias as atrial fibrillation (AF) or atrial tachycardia (AT) according to their rate, atrioventricular association and regularity. ATP therapies and prevention algorithms were enabled at first month follow-up visit. ATP therapies were programmed to treat episodes classified as AT at their onset or during their progression. Therapies were automatically delivered 1 min after episode detection.

Results During a follow up of 3.3 ± 2.9 months, 5593 AT/AF episodes were detected and treated in 21 patients, and 2065 (36%) were classified by the device as successfully terminated. In a subgroup of patients for whom electrogram information was available, the device classified 96 (37.4%) of the 256 recorded episodes as successfully terminated. The effect of ATP on AF burden was closely related to the efficacy of ATP. A reduction in AF burden was more evident in those patients in whom ATP therapy efficacy was greater than 50% in terminating episodes. ATP efficacy was greater (52.6%) in episodes classified at onset as AT than in those classified at onset as AF (28.6%). ATP efficacy was also higher in patients with long pre-therapy P-P cycle interval and in patients with atrial lead implanted at the inter-atrial septum.

Conclusion The present study demonstrates the safety and efficacy of automatic ATP therapies for terminating AT/AF, with a sophisticated dual-chamber pacemaker. Atrial ATP terminated 36.9% of treated AT/AF episodes without any proarrhythmic effects in a population of patients with indications for pacemaker implantation and/or a history of AF.

Key Words: Antitachycardia pacing • atrial fibrillation • dual-chamber pacing

References

  1. Ryder KM, Benjamin EJ. Epidemiology and significance of atrial fibrillation. Am J Cardiol. 1999;84:131R–138R[CrossRef][Web of Science][Medline]
  2. Benjamin EJ, Wolff PA, D'agostino RB, Silbershatz H, Kannel WB, Levy D. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation. 1995;92:835–841[Abstract/Free Full Text]
  3. Rosenqvist M, Brandt J, Schuller H. Long-term pacing in sinus node disease: effect of stimulation mode on cardiovascular mortality and morbility. Am Heart J. 1988;116:16–22[CrossRef][Web of Science][Medline]
  4. Andersen HR, Nielsen JC, Thomsen PE, et al. Long-term followup of patients from a randomised trial of atrial versus ventricular pacing for sick-sinus syndrome. Lancet. 1997;350:1210–1216[CrossRef][Web of Science][Medline]
  5. Lamas GA, Orav EJ, Stambler BS, Pace-Maker Selection in the Elderly Investigators, et al. Quality of life and clinical outcomes in elderly patients treated with ventricular pacing as compared with dual-chamber pacing. for theN Eng J Med. 1998;338:1097–1104[Abstract/Free Full Text]
  6. Katsivas A, Manolis AG, Lazaris E, et al. Atrial septal pacing to synchronize atrial depolarization in patients with delayed interatrial conduction. Pacing Clin Electrophysiol. 1998;21:2220–2225[CrossRef][Medline]
  7. Padeletti L, Porciani MC, Michelucci A, et al. Interatrial septum pacing: a new approach to prevent recurrent atrial fibrillation. J Interv Card Electrophysiol. 1999;3:35–43[CrossRef][Web of Science][Medline]
  8. Disertori M, Furlanello F, Vergara G, Inama G, Guamerio M, Cozzi E. Clinical experience with a dual chamber automatic antitachycardia pacemaker (Symbios 7008) in the treatment of atrial flutter. [abstract]Pacing Clin Electrophysiol. 1987;10:669
  9. Disertori M, Furlanello F, Vergara G, Inama G, Guamerio M, Cozzi F. The management of paroxysmal supraventricular tachycardia using the Orthocor II pacemaker. Clinical experience. [abstract]Pacing Clin Electrophysiol. 1987;10:669
  10. Swerdlow CD, Schols W, Dijkman B, et al. Detection of atrial fibrillation and flutter by a dual chamber implantable cardioverterdefibrillator. Circulation. 2000;101:878–885[Abstract/Free Full Text]
  11. Dijkman B, Wellens HJJ. Diagnosis and therapy of atrial tachyarrhythmias in the dual chamber implantable cardioverter defibrillator. J Cardiovasc Electrophysiol. 2000;11:1196–1205[CrossRef][Web of Science][Medline]
  12. Ricci R, Santini M, Disertori M, et al. Atrial anti-tachycardia pacing therapy efficacy strongly depends on atrial arrhythmias cycles: implication in dual ICD. [abstract]Eur Heart J. 2000;21:122 (abstract suppl)
  13. Disertori M, Capucci A, Ricci R, et al. Efficacy of anti-tachy-pacing therapies and low energy cardioversion in terminating spontaneous atrial tachyarrhythmias in patients with dual implantable defibrillator. [abstract]Europace. 2000;1(suppl D):148/2
  14. Gregoratos G, Cheltin MD, Conill A, et al. ACC/AHA Guidelines for implantation of cardiac pacemakers and antiarrhythmia devices: executive summary. A report of American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Pacemaker Implantation). Circulation. 1998;97:1325–1335[Free Full Text]
  15. Gillberg J, Brown M, Stanton M, Hammill S, Olson W. Clinical testing of a dual chamber atrial tachyarrhythmia detection algorithm. Comput Cardiol. 1996;:57–60
  16. Brown M, Gilbert J, Stanton M, Hammill S, Olson W. Acute human testing of a dual chamber ventricular tachyarrhythmia detection algorithm at Mayo Clinic. Comput Cardiol. 1996;:61–64
  17. Allessie MA. Atrial electrophysiologic remodeling: another vicious circle? J Cardiovasc Electrophysiol. 1998;9:1378–1393[Web of Science][Medline]
  18. Pandozi C, Santini M. Update on atrial remodeling owing to rate. Does atrial fibrillation always beget atrial fibrillation? Eur Heart J. 2001;22:541–553[Free Full Text]
  19. Allessie MA, Kirchof C, Scheffer GJ, et al. Regional control of atrial fibrillation by rapid pacing in conscious dogs. Circulation. 1991;84:1689–1697[Abstract/Free Full Text]
  20. Kirchof C, Chorro F, Scheffer GJ, et al. Regional entrainement of atrial fibrillation studies by high-resolution mapping in open-chest dogs. Circulation. 1993;88:736–749[Abstract/Free Full Text]
  21. Kalman JM, Olgin JE, Kark MR, et al. Regional entrainement of atrial fibrillation in man. J Cardiovasc Electrophysiol. 1996;7:867–876[Web of Science][Medline]
  22. Paldino W, Bahu M, Knight BP, et al. Failure of single-and multisite high-frequency atrial pacing to terminate atrial fibrillation. Am J Cardiol. 1997;80:226–227[CrossRef][Web of Science][Medline]
  23. Pandozi C, Bianconi L, Villani M, et al. Local capture by atrial pacing in spontaneous chronic atrial fibrillation. Circulation. 1997;95:2416–2422[Abstract/Free Full Text]
  24. Wells JL, MacLean WAH, James TN, et al. Characterization of atrial flutter: studies in man after open-heart surgery using fixed atrial electrodes. Circulation. 1979;60:655–671[Free Full Text]
  25. Disertori M, Molinis G, Inama G, et al. Overdrive and programmed atrial electrostimulation in the study of the electrophysiological mechanism of atrial flutter in man. Pacing Clin Electrophysiol. 1981;4:133–147[CrossRef][Medline]
  26. Peters RW, Shorofsky SR, Pelini M, et al. Overdrive atrial pacing for conversion of atrial flutter: comparison of postoperative with nonpostoperative patients. Am Heart J. 1999;137:100–103[CrossRef][Web of Science][Medline]
  27. Orlansky B, Okumura K, Hhess PG, et al. Use of procainamide with rapid atrial pacing for successful conversion of atrial flutter to sinus rhythm. J Am Coll Cardiol. 1988;11:359–364[Abstract]
  28. Della Bella P, Tondo C, Marenzi G, et al. Facilitating influence of disopyramide on atrial flutter termination by overdrive pacing. Am J Cardiol. 1988;61:1046–1049[CrossRef][Web of Science][Medline]
  29. Stambler BS, Wood MA, Ellenbogen KA. Comparative efficacy of intravenous ibutilide versus procainamide for enhancing termination of atrial flutter by atrial overdrive pacing. Am J Cardiol. 1996;77:960–966[CrossRef][Web of Science][Medline]
  30. Tai CT, Chen SA, Feng AN, et al. Electrophysilogic effect of class I and class II antiarrhythmic drugs on typical atrial flutter. Insights into the mechanism of termination. Circulation. 1998;97:1935–1945[Abstract/Free Full Text]
  31. Wijffels MCEF, Dorland R, Mast F, et al. Widening of the excitable gap during pharmacological cardioversion of atrial fibrillation in the goat. Effects of cibenzoline, hydroquinidine, flecainide, and d-sotalol. Circulation. 2000;102:260–267[Abstract/Free Full Text]
  32. Gaita F, Calo L, Ricciardi R, et al. Different patterns of atrial activation in idiopathic atrial fibrillation: simultaneous multisite atrial mapping in patients with paroxysmal and chronic atrial fibrillation. J Am Coll Cardiol. 2001;37:534–541[Abstract/Free Full Text]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?



This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Disclaimer
Right arrow Request Permissions
Google Scholar
Right arrow Articles by Disertori, M.
Right arrow Articles by Vimercati, M.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Disertori, M.
Right arrow Articles by Vimercati, M.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?