Circulation. 2001;104:1023-1028
doi: 10.1161/hc3401.095039
doi: 10.1161/hc3401.095039
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(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
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|
|
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|
|
|
|
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|
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|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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]
|
|
|
|
|
|
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|
|
|
|
|
|
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]
|
|