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Effects of consistent atrial pacing and atrial rate stabilization - two pacing algorithms to suppress recurrent paroxysmal atrial fibrillation in brady-tachy syndrome

G. Boriani*,1, M. Biffi1, L. Padeletti2, A. Sparnpinato3, G. Luca Botto4, C. Pignalberi5, A. Grammatico6, D.A. Hettrick6, F. De Seta6 and A. Branzi1

a Institute of Cardiology, University of Bologna, Bologna, Italy
b Clinica Medica, University of Firenze, Firenze, Italy
c Villa Tiberia, Roma, Italy
d S. Anna Hospital, Como, Italy
e Universita' Campus Biomedico, Roma, Italy
f Medtronic Inc., Roma, Italy

* Correspondence: Dr Giuseppe Boriani, MD, FESC, Institute of Cardiology, Policlinico S. Orsola-Malpighi, Via Massarenti 9, 40138 Bologna, Italy.

Abstract

Background and method Recently, various dedicated atrial pacing algorithms have been proposed to prevent atrial fibrillation (AF). Consistent atrial pacing (CAP; an algorithm for automatic atrial overdrive) and atrial rate stabilization (ARS; an algorithm for preventing the ‘short-long’ sequences) were tested in 16 patients with brady-tachy syndrome and recurrent paroxysmal AF (≥3 episodes per month).

Results In the population as a whole, pacing with CAP was associated with a significant reduction in AF burden in comparison with DDDR pacing. With regard to the effects on AF burden, 11 patients (69%) were found to benefit significantly from CAP or ARS pacing algorithms (reduction >50% in AF burden). In detail, seven patients were responders to both algorithms, two to CAP only and two to ARS only. Two patients exhibited a significant increase in AF burden with the ARS algorithm. With regard to the effects on number of mode switches per day, seven patients (44%) were found to benefit significantly from CAP or ARS pacing algorithms (reduction in mode switches per day >50%). In detail, five patients were responders to both algorithms and two to ARS only. Two patients had a significant increase in the number of mode switches per day with both CAP and ARS algorithms.

Conclusion The response to ARS and CAP algorithms is heterogeneous. In 31–69% of patients with brady-tachy syndrome a significant reduction in AF burden and/or mode switch episodes can be obtained with ARS and/or CAP algorithms; however, in a few patients an increase in AF episodes and/or AF burden may occur

Key Words: Atrial fibrillation • brady-tachy syndrome • dual-chamber pacing • pacing algorithms • overdrive atrial pacing • rate responsive

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