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Antitachycardia pacing therapy to treat spontaneous atrial tachyarrhythmias: the 7250 dual defibrillator Italian Registry

R. Ricci*,1, C. Pignalberil, M. Disertori2, A. Capucci3, L. Padeletti4, G. Botto5, G. Boriani6, F. Miraglia7, T. de Santo7 and M. Santini1

a San Filippo Neri Hospital, Rome, Italy
b Santa Chiara Hospital, Trento, Italy
c Civile Hospital, Piacenza, Italy
d Careggi Hospital, Florence, Italy
e S. Anna Hospital, Como, Italy
f Sant'Orsola Hospital, Bologna, Italy
g Medtronic, Rome, Italy

* Correspondence: Dr Renato Ricci, Via Antonio Sogliano 84, 00164 Rome, Italy.

Abstract

Background The dual defibrillator is a new device that can deliver atrial antitachycardia pacing (ATP) and shock therapies to treat atrial tachyarrhythmias in patients with and without life-threatening ventricular tachyarrhythmias. The aims of the present study were to investigate the efficacy of ATP and to identify factors that may impact on success of treatment.

Method A total of 105 patients (80 male, mean age 64 ± 10 years) implanted with a dual defibrillator were enrolled in the study; 66% had documented atrial fibrillation (AF) before implantation and 14% had no history of prior ventricular tachyarrhythmias.

Results The follow-up lasted 6 ± 5 months (range 1–24 months). A total of 863 treated atrial episodes were analyzed; 54.8% were classified as AF and 45.2% as atrial tachycardia (AT). The positive predictive value for atrial tachyarrhythmia was 97.7%. The efficacy of atrial ATP therapy was as follows: 48% overall, 70.9% on AT and 24.3% on AF. The overall efficacy of atrial shock was 100% for AT and 80% for AF. Atrial burst+ and ramp efficacy correlated well with atrial arrhythmia cycle length, whereas 50-Hz burst did not. As ATP delivery delay increased from 0 to 30 min, the mean atrial arrhythmia cycle length shortened and ATP efficacy decreased. Class IC drug treatment was associated with longer mean atrial cycles as compared with no therapy or with class III drugs.

Conclusion ATP therapies afforded by dual defibrillators were highly effective in treating spontaneous atrial tachyarrhythmias. Early treatment of such arrhythmias should improve success rates and patient benefits.

Key Words: Atrial fibrillation • dual defibrillator • antitachycardia pacing • antiarrhythmic drugs

References

  1. Kannel WB, Abbott RD, Savage DD, et al. Epidemiologic features of chronic atrial fibrillation: the Framingham study. N Engl J Med. 1982;306:1018–1022[Abstract]
  2. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham study. Stroke. 1991;22:983–988[Abstract/Free Full Text]
  3. Pritchett EEC, Mc Carthy EA, Wilkinson WE. Propafenone treatment of symptomatic paroxysmal supraventricular arrhythmias. A randomized, placebo-controlled, crossover trial in patients tolerating oral therapy. Ann Intern Med. 1991;114:539–544
  4. Flaker GC, Blackshear JL, McBride R, Kronmal RA, Halperin JL, Hart RG, Stroke Prevention in Atrial Fibrillation Investigators. J Am Coll Cardiol. 1992;20:527–532[Abstract]
  5. Wharton M, Santini M. Treatment of spontaneous atrial tachyarrhytmias with the Medtronic 7250 Jewel AF: worldwide clinical experience. Worldwide Jewel AF InvestigatorsCirculation. 1998;98:I–190 [abstract]
  6. Jung W, Wolpert C, Esmailzadeh B, et al. Clinical experience with implantable atrial and combined atrioventricular defibrillators. J Interv Card Electrophysiol. 2000;4:185–195
  7. Liang KY, Zeger SL. Longitudinal data analysis using generalized linear models. Biometrika. 1986;73:13–22[Abstract/Free Full Text]
  8. MacDonald P, Hackworthy R, Keogh A, et al. Atrial overdrive pacing for reversion of atrial flutter after heart transplantation. J Heart Lung Transplant. 1991;10:731–737[Web of Science][Medline]
  9. Peters RW, Shorofsky SR, Pelini M, et al. Overdrive atrial pacing for reversion of atrial flutter: comparison of postoperative with nonpostoperative patients. Am Heart J. 1999;137:100–103[CrossRef][Web of Science][Medline]
  10. Baeriswyl G, Zimmermann M, Adamec R. Efficacy of rapid atrial pacing for conversion of atrial flutter in medically treated patients. Clin Cardiol. 1994;17:246–250[Web of Science][Medline]
  11. Gloor HO, Fromer M, Kappenberger L. Endocardial conversion of atrial flutter. Success rate of various stimulation protocols. Clin Prog Electrophysiol Pacing. 1986;4:67–75
  12. Hii JTY, Mitchell B, Duff FU, et al. Comparison of atrial overdrive pacing with and without extrastimuli for termination of atrial flutter. Am J Cardiol. 1992;70:463–467[CrossRef][Web of Science][Medline]
  13. Kirchhof C, Chorro F, Scheffer GJ, et al. Regional entrainment of atrial fibrillation studied by high-resolution mapping in openchest dogs. Circulation. 1993;88:736–749[Abstract/Free Full Text]
  14. 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]
  15. Mongeon L, Hill M, Lahtinen S, Hansen N, Mehra R. Canine model of sustained atrial fibrillation is associated with electrophysiological remodeling. [abstract]Pacing Clin Electrophysiol. 1995;18:II–934
  16. Capucci A, Biffi M, Boriani G, et al. Dynamic electrophysiological behaviour of human atria during paroxysmal atrial fibrillation. Circulation. 1995;92:1193–1202[Abstract/Free Full Text]
  17. Paladino 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]
  18. Giorgberidze I, Saksena S, Mongeon L, et al. Effects of highfrequency atrial pacing in atypical atrial flutter and atrial fibrillation. J Interv Card Electrophysiol. 1997;1:111–123[CrossRef][Medline]
  19. Mehra R, Mongeon L. Termination of atrial tachyarrhythmias by pacing techniques. Santini M. Progress in Clinical Pacing. Armonk, New York: Futura; 1996. p. 491–502
  20. 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]
  21. Israel CW, Gronefel G, Klesius A, Lawo T, Hohnloser SH. Incidence of atrial flutter in patients with a hystory of paroxysmal atrial fibrillation: implications for atrial antitachycardia pacing. [abstract]Pacing Clin Electrophysiol. 2000;23:682
  22. Biffi M, Boriani G, Bronzetti G, Capucci A, Branzi A, Magnani B. Electrophysiological effects of flecainide and propafenone on atrial fibrillation cycle and relation with arrhythmia termination. Heart. 1999;82:176–182[Abstract/Free Full Text]
  23. Wijffels MC, Dorland R, Mast F, Allessie MA. 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]
  24. Yu WC, Chen SA, Lee SH, et al. Tachycardia-induced change of atrial refractory period in humans: rate dependency and effects of antiarrhythmic drugs. Circulation. 1998;97:2331–2337[Abstract/Free Full Text]

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