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Efficacy of atrial antitachycardia pacing using the Medtronic AT500 pacemaker in patients with congenital heart disease
Abstract
Patients with congenital heart disease are vulnerable to atrial tachyarrhythmias, especially after atrial surgeries. We evaluated the efficacy of atrial arrhythmia detection and antitachycardia pacing (ATP) using the Medtronic AT500 pacemaker in 28 patients with congenital heart disease (age 30 +/- 18 years). Of 15 patients with atrial arrhythmias, 14 had atrial tachycardia events that were appropriately detected. ATP was enabled for 167 treatable episodes, successfully converting 90 (54%). Rhythms classified as ventricular tachycardia were detected 127 times, yet most were actually atrial or sinus tachycardia with 1:1 atrioventricular conduction. Atrial tachycardias in congenital heart disease are amenable to ATP algorithms in the AT500 pacemaker.
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“Alternatively, AFL interruption can be achieved in a large percentage of cases by atrial pacing at rates above the AFL rate, through a transvenous catheter.”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [148]
In the citing paper
“Using high output stimulation this technique can also be applied through the oesophagus.145 -148”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [148]
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“The clinical results from prospective, multi-centre antitachycardia pacing trials using devices equipped with special algorithms suggest reasonable efficacy (54%) in selected groups of patients.(187) In these cases, it must be kept in mind that anti-tachycardia pacingmay lead toa further acceleration in the atrial arr…”
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Bhatt, A. B., Foster, E., KUEHL, K. S., Alpert, J. S., Brabeck, S., Crumb, S. R., Davidson, W. R., Earing, M. G., Ghoshhajra, B. B., Karamlou, T., et al. (2015) · Circulation · doi:10.1161/cir.0000000000000204 · Cited by 258
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“Atrial pacing may be reasonable to decrease recurrences of AT or atrial flutter in ACHD patients and sinus node dysfunction.(344,374,375)”
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“may be difficult to treat pharmacologically and may require (a combination of) catheter ablation or atrial antitachycardia pacing.(16,17) The purpose of the present study was to explore whether the pacing mode may play a role in the prevention of atrial arrhythmias in CHD patients who had a bradycardia indication for…”
BackgroundShah, M. J., Silka, M. J., Silva, J. N. A., Balaji, S., Beach, C. M., Benjamin, M. N., Berul, C. I., Cannon, B. C., Cecchin, F., Cohen, M. I., et al. (2021) · Indian Pacing and Electrophysiology Journal · doi:10.1016/j.ipej.2021.07.005 · Cited by 16
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“…in CHD patients with recurrent intra-atrial reentrant tachycardia in whom ablation or medications were ineffective or not acceptable treatment [36,37]; atrial or dual-chamber pacing in patients with complex CHD and with impaired hemodynamic caused by sinus bradycardia or loss of AV synchrony…”
BackgroundRecognition and management of arrhythmias in adult congenital heart disease
McLeod, C. J., & Warnes, C. (2016) · Current Opinion in Cardiology · doi:10.1097/hco.0000000000000251 · Cited by 11
Pacing in adults with congenital heart disease
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Postoperative arrhythmias in tetralogy of Fallot.
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Dubin, A. M., Cannon, B. C., Saarel, E. V., Triedman, J. K., Berul, C. I., Bar‐Cohen, Y., Shah, M. J., Paulsen, J., Patel, H. J., Reich, J. D., et al. (2018) · Heart Rhythm · doi:10.1016/j.hrthm.2018.12.021 · Cited by 10
“Sporadic reports of pediatric-specific events are published by industry-clinician collaborations, but these are relatively rare compared to large adult studies.(3) Reporting of adverse events associated with off-label use may be lacking, which may compromise opportunities to optimize device use in these respective pop…”
ResultThe role of pacing in rhythm control and management of atrial fibrillation
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“[70, 103] With therapies active AT/AF burden was 4.”
BackgroundManagement of tachyarrhythmias in pregnancy – A review
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“In the setting of structural heart disease, sustained tachycardia may cause hemodynamic compromise and placental hypoperfusion, and sinus rhythm should be restored as soon as possible with pharmacologic or direct-current cardioversion, or overdrive atrial pacing.(107,108) In the setting of hemodynamic instability, imm…”
BackgroundAdvances in pediatric electrophysiology
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Pacing for Sinus Node Disease: Indications, Techniques, and Clinical Trials
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Cardioversion of Intraatrial Reentrant Tachycardia Using Rate Response
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“Therefore, the implantation of a pacemaker with the ability of atrial overdrive stimulation to terminate atrial arrhythmias in patients with drug refractory tachycardias is a potential treatment option.(4)”
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Metadata
- Authors
- Stephenson, E. A., Casavant, D., Tuzi, J., Alexander, M. E., Law, I., Serwer, G., Strieper, M., Walsh, E. P., & Berul, C. I.
- Affiliations
- Boston Children's Hospital (US)
- Medtronic (United States) (US)
- Harvard University (US)
- University of Iowa (US)
- Children's Healthcare of Atlanta (US)
- Corresponding author
- Berul, Charles I.
- ORCID
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2003-10
- Volume
- 92
- Issue
- 7
- Pages
- 871-876
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W2107655703
- Cited by
- 141
- References
- 22
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 2 · 2022: 7 · 2021: 10 · 2020: 1 · 2019: 4 · 2018: 10 · 2017: 10 · 2016: 4 · 2015: 15 · 2014: 6 · 2013: 4 · 2012: 9
- FWCI
- 4.85
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Congenital Heart Disease Studies
- Keywords
- congenital heart disease, atrial tachycardia, atrial arrhythmia detection, atrioventricular conduction, postoperative arrhythmia, implantable cardioverter-defibrillator
- MeSH terms
- Adolescent, Adult, Aged, Atrial Fibrillation, Atrial Flutter, Cardiac Pacing, Artificial, Child, Female, Follow-Up Studies, Heart Defects, Congenital, Humans, Male, Middle Aged, Pacemaker, Artificial, Tachycardia, Atrioventricular Nodal Reentry, Tachycardia, Supraventricular, Treatment Outcome
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