Circulation. 2001;104:1023-1028
doi: 10.1161/hc3401.095039
doi: 10.1161/hc3401.095039
(Circulation. 2001;104:1023.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Atrial Therapies Reduce Atrial Arrhythmia Burden in Defibrillator Patients
From the Mayo Clinic, Rochester, Minn (P.A.F., S.C.H.); the University of Maastricht, Maastricht, the Netherlands (B.D.); and Medtronic, Inc, Minneapolis, Minn (E.N.W., H.A.X., R.M., M.S.S.).
Correspondence to Paul A. Friedman, MD, Department of Internal Medicine and Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail pfriedman@ mayo.edu
Background— Approximately 25% of patients who receive an implantable cardioverter-defibrillator (ICD) to treat ventricular tachyarrhythmias have documented atrial tachyarrhythmias before implantation. This study assessed the ability of device-based prevention and termination therapies to reduce the burden of spontaneous atrial tachyarrhythmias.
Methods and Results— Patients with a standard indication for the implantation of an ICD and 2 episodes of atrial tachyarrhythmias in the preceding year received a dual-chamber ICD (Medtronic 7250 Jewel AF) that uses pacing and shock therapies for prevention and/or termination of atrial tachyarrhythmias. In a multicenter trial, patients were randomized to 3-month periods with atrial therapies "on" or "off" and subsequently crossed over. Analysis was performed on the 52 of 269 patients who had episodes of atrial tachyarrhythmia and had 
30 days of follow-up with atrial therapies on and off. The atrial therapies resulted in a reduction of atrial tachyarrhythmia burden from a mean of 58.5 to 7.8 h/mo. A paired analysis (Wilcoxon signed-rank test) showed that the median difference in burden (1.1 h/mo) was highly significant (P=0.007). When the subgroup of 41 patients treated only with atrial pacing therapies was analyzed, the reduction in burden persisted (P=0.01).
Conclusions— In this study, patients with a standard ICD indication and atrial tachyarrhythmias had a significant reduction in atrial tachyarrhythmia burden with use of atrial pacing and shock therapies.
Key Words: tachyarrhythmias • atrium • atrial flutter • fibrillation • defibrillation • pacing
This article has been cited by other articles:
 |
|
 |
|
  A. M. Gillis, M. Morck, D. V. Exner, R. S. Sheldon, H. J. Duff, B. L. Mitchell, and G. D. Wyse Impact of atrial antitachycardia pacing and atrial pace prevention therapies on atrial fibrillation burden over long-term follow-up Europace, August 1, 2009; 11(8): 1041 - 1047. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. P. Ricci, A. Quesada, J. Almendral, F. Arribas, C. Wolpert, P. Adragao, M. Zoni-Berisso, X. Navarro, T. DeSanto, A. Grammatico, et al. Dual-chamber implantable cardioverter defibrillators reduce clinical adverse events related to atrial fibrillation when compared with single-chamber defibrillators: a subanalysis of the DATAS trial Europace, May 1, 2009; 11(5): 587 - 593. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. J. Camm, P. Kirchhof, G. Y.H. Lip, I. Savelieva, and S. Ernst CHAPTER 29 Atrial Fibrillation ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. M. Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, D. L. Hayes, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons J. Am. Coll. Cardiol., May 27, 2008; 51(21): e1 - e62. [Full Text] [PDF]
|
|
|
|
 |
|
 Writing Committee Members, A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. M. Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons Circulation, May 27, 2008; 117(21): e350 - e408. [Full Text] [PDF]
|
|
|
|
|
|
M. E.W. Hemels, J. H. Ruiter, G. P. Molhoek, N. J.G.M. Veeger, A. C.P. Wiesfeld, A. V. Ranchor, M. van Trigt, A. Pilmeyer, I. C. Van Gelder, and for The Features in AT500TM study; Chances for pat Right atrial preventive and antitachycardia pacing for prevention of paroxysmal atrial fibrillation in patients without bradycardia: a randomized study Europace, March 1, 2008; 10(3): 306 - 313. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Mont, R. Ruiz-Granell, J. G. Martinez, J. R. Carmona, M. Fidalgo, E. Cobo, M. Riera, X. Navarro, and on behalf of the Prevention or Termination (POT) S Impact of anti-tachycardia pacing on atrial fibrillation burden when added on top of preventive pacing algorithms: results of the prevention or termination (POT) trial Europace, January 1, 2008; 10(1): 28 - 34. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Gradaus, K. Seidl, T. Korte, E. Himmrich, H. Wieneke, A. Schuchert, W. Bauer, J. Gerss, C. G. Wollmann, M. Borggrefe, et al. Reduction of ventricular tachyarrhythmia by treatment of atrial fibrillation in ICD patients with dual-chamber implantable cardioverter/defibrillators capable of atrial therapy delivery: the REVERT-AF Study Europace, July 1, 2007; 9(7): 534 - 539. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Developed in Collaboration With the European Heart, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) J. Am. Coll. Cardiol., September 5, 2006; 48(5): e247 - e346. [Full Text] [PDF]
|
|
|
|
|
|
Writing Committee Members, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society Europace, September 1, 2006; 8(9): 746 - 837. [Full Text] [PDF]
|
|
|
|
|
|
M. Gulizia, S. Mangiameli, S. Orazi, G. Chiaranda, G. Boriani, G. Piccione, N. DiGiovanni, A. Colletti, C. Puntrello, G. Butera, et al. Randomized comparison between Ramp and Burst+ atrial antitachycardia pacing therapies in patients suffering from sinus node disease and atrial fibrillation and implanted with a DDDRP device Europace, July 1, 2006; 8(7): 465 - 473. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Drago, M. S. Silvetti, G. Grutter, and A. De Santis Long term management of atrial arrhythmias in young patients with sick sinus syndrome undergoing early operation to correct congenital heart disease Europace, July 1, 2006; 8(7): 488 - 494. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Schwartzman, M. N. Harvey, R. H. Hoyt, J. L. Koehler, M. R. Ujhelyi, and D. E. Euler Utility of adjunctive single oral bolus propafenone therapy in patients with atrial defibrillators. Europace, March 1, 2006; 8(3): 211 - 215. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Z. Goldberger and R. Lampert Implantable Cardioverter-Defibrillators: Expanding Indications and Technologies JAMA, February 15, 2006; 295(7): 809 - 818. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. E.W. Hemels, A. C.P. Wiesfeld, B. Inberg, P. F.H.M. Van Dessel, W. Nieuwland, E. S. Tan, H. Mulder, D. J. Van Veldhuisen, and I. C. Van Gelder Right atrial overdrive pacing for prevention of symptomatic refractory atrial fibrillation. Europace, February 1, 2006; 8(2): 107 - 112. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. P. Knight, B. J. Gersh, M. D. Carlson, P. A. Friedman, R. L. McNamara, S. A. Strickberger, H. F. Tse, A. L. Waldo, and for the AHA Writing Group Role of Permanent Pacing to Prevent Atrial Fibrillation: Science Advisory From the American Heart Association Council on Clinical Cardiology (Subcommittee on Electrocardiography and Arrhythmias) and the Quality of Care and Outcomes Research Interdisciplinary Working Group, in Collaboration With the Heart Rhythm Society Circulation, January 18, 2005; 111(2): 240 - 243. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Padeletti, M. Santini, G. Boriani, G. Botto, A. Capucci, M. Gulizia, R. Ricci, A. Spampinato, P. Pieragnoli, E. Warman, et al. Temporal variability of atrial tachyarrhythmia burden in bradycardia-tachycardia syndrome patients Eur. Heart J., January 2, 2005; 26(2): 165 - 172. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.C. Geller, S. Reek, C. Timmermans, T. Kayser, H.-F. Tse, C. Wolpert, W. Jung, A.J. Camm, C.-P. Lau, H. J.J. Wellens, et al. Treatment of atrial fibrillation with an implantable atrial defibrillator -- long term results Eur. Heart J., December 1, 2003; 24(23): 2083 - 2089. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Lee, R. Weachter, S. Pollak, M. S. Kremers, A. M. Naik, R. Silverman, J. Tuzi, W. Wang, L. J. Johnson, D. E. Euler, et al. The effect of atrial pacing therapies on atrial tachyarrhythmia burden and frequency: Results of a randomized trial in patients with bradycardia and atrial tachyarrhythmias J. Am. Coll. Cardiol., June 4, 2003; 41(11): 1926 - 1932. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. L. Page, T. W. Tilsch, S. J. Connolly, D. J. Schnell, S. R. Marcello, W. E. Wilkinson, E. L.C. Pritchett, and for the Azimilide Supraventricular Arrhythmia Prog Asymptomatic or "Silent" Atrial Fibrillation: Frequency in Untreated Patients and Patients Receiving Azimilide Circulation, March 4, 2003; 107(8): 1141 - 1145. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. F. Lozano, A. Vincent, J. Roda, M. Méndez, J. M. M. Ferrer, F. Andrade, J. J. Manzano, R. Ceres, J. Errejon, and J. Toquero Paroxysmal atrial fibrillation prevention by pacing in patients with pacemaker indication Europace, January 1, 2003; 5(3): 267 - 273. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Santini and R. Ricci Atrial fibrillation and heart failure Europace, January 1, 2003; 5(s1): S55 - S59. [Full Text] [PDF]
|
|
|
|
 |
|
 C.-P. Lau Pacing for atrial fibrillation Heart, January 1, 2003; 89(1): 106 - 112. [Full Text] [PDF]
|
|
|
|
|
|
T. H. Everett IV, J. G. Akar, L.-C. Kok, J. R. Moorman, and D. E. Haines Use of global atrial fibrillation organization to optimize the success of burst pace termination J. Am. Coll. Cardiol., November 20, 2002; 40(10): 1831 - 1840. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. Gillis, C. Unterberg-Buchwald, H. Schmidinger, S. Massimo, K. Wolfe, D. J. Kavaney, M. F. Otterness, S. H. Hohnloser, and GEM III AT Worldwide Investigators Safety and efficacy of advanced atrial pacing therapies for atrial tachyarrhythmias in patients with a new implantable dual chamber cardioverter-defibrillator J. Am. Coll. Cardiol., November 6, 2002; 40(9): 1653 - 1659. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M.J.P. Raatikainen and H.V. Huikuri Management of atrial fibrillation in patients with implantable cardioverter defibrillator. Do all need a dual chamber device? Eur. Heart J., September 2, 2002; 23(18): 1412 - 1414. [Full Text] [PDF]
|
|
|
|
|
|
K. M. Stein, D. E. Euler, R. Mehra, K. Seidl, D. J. Slotwiner, S. Mittal, S. M. Markowitz, B. B. Lerman, and Jewel AF Worldwide Investigators Do atrial tachyarrhythmias beget ventricular tachyarrhythmias in defibrillator recipients? J. Am. Coll. Cardiol., July 17, 2002; 40(2): 335 - 340. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. Cooper, M. S. Katcher, and M. V. Orlov Implantable Devices for the Treatment of Atrial Fibrillation N. Engl. J. Med., June 27, 2002; 346(26): 2062 - 2068. [Full Text] [PDF]
|
|
|
|
|
|
S.R. Raj and D.G. Wyse Rhythm control for paroxysmal atrial fibrillation after AV junction ablation: is it worth the effort? Eur. Heart J., June 1, 2002; 23(11): 845 - 848. [Full Text] [PDF]
|
|
|
|
|
|
J. C. Daubert and P. Mabo Implantable devices to treat atrial fibrillation: real prospects or just new gimmicks? Europace, January 1, 2002; 4(2): 161 - 164. [PDF]
|
|
|
|
|
|
W. Xu, H.-F. Tse, F. H.Y. Chan, P. C. W. Fung, K. L.-F. Lee, and C.-P. Lau New Bayesian Discriminator for Detection of Atrial Tachyarrhythmias Circulation, March 26, 2002; 105(12): 1472 - 1479. [Abstract] [Full Text] [PDF]
|
|