Τίτλος:
New-generation atrial antitachycardia pacing (Reactive ATP) is
associated with reduced risk of persistent or permanent atrial
fibrillation in patients with bradycardia: Results from the MINERVA
randomized multicenter international trial
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
BACKGROUND Atrial fibrillation (AF) is a frequent comorbidity in
patients with pacemaker and is a recognized cause of mortality,
morbidity, and quality-of-life impairment. The international MINimizE
Right Ventricular pacing to prevent Atrial fibrillation and heart
failure trial established that atrial preventive pacing and atrial
antitachycardia pacing (DDDRP) in combination with managed ventricular
pacing (MVP) reduce permanent AF occurrence in comparison with standard
dual-chamber pacing (DDDR).
OBJECTIVE We aimed to determine the role of new-generation atrial
antitachycardia pacing (Reactive ATP) in preventing AF disease
progression.
METHODS Patients with dual-chamber pacemaker and with previous atrial
tachyarrhythmias were randomly assigned to DDDR (n = 385 (3310)), MVP (n
= 398 (34%)), or DDDRP+MVP (n = 383 (33%)) group. The incidence of
permanent AF, as defined by the study investigator, or persistent AF,
defined as >= 7 consecutive days with AF, was estimated using the
Kaplan-Meier method, while its association with patients’
characteristics was evaluated via multivariable Cox regression.
RESULTS At 2 years, the incidence of permanent or persistent AF was 26%
(95% confidence interval [CI] 22%-31%) in the DDDR group, 25%
(95% CI 21%-30%) in the MVP group, and 15% (95% CI 12%-20%) in
the DDDRP+MVP group (P < .001 vs DDDR; P = .002 vs MVP). Generalized
estimating equation-adjusted Reactive ATP efficacy was 44.4% (95% CI
41.3%-47.6%). Multivariate modeling identified high Reactive ATP
efficacy (> 44.4%) as a significant predictor of reduced permanent or
persistent AF risk (hazard ratio 0.32; 95% CI 0.13-0.781; P = .012) and
episodes’ characteristics, such as long atrial arrhythmia cycle length,
regularity, and the number of rhythm transitions, as predictors of high
ATP efficacy.
CONCLUSION In patients with bradycardia, DDDRP+MVP delays AF disease
progression, with Reactive ATP efficacy being an independent predictor
of permanent or persistent AF reduction.
Συγγραφείς:
Padeletti, Luigi
Puererfellner, Helmut
Mont, Lluis
Tukkie,
Raymond
Mano, Antonis S.
Ricci, Renato
Mama, Giuseppe and
Serra, Paolo
Scheffer, Mike G.
Martins, Vitor
Warman,
Eduardo N.
Vimercati, Marco
Grammatico, Andrea
Boriani,
Giuseppe
MINERVA Invest
Εκδότης:
EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
Λέξεις-κλειδιά:
Atrial fibrillation; Pacemaker; Antitachycardia pacing; Reactive ATP
DOI:
10.1016/j.hrthm.2015.04.015
