Improved suppression of recurrent atrial fibrillation with dual-site right atrial pacing and antiarrhythmic drug therapy
Open accessAbstract
Objectives We compared the safety, tolerance and effectiveness of overdrive high right atrial (RA), dual-site RA and support (DDI or VDI) pacing (SP) in patients with symptomatic atrial fibrillation (AF) and bradycardias.Background Optimal pacing methods for AF prevention remain unclear.Methods Patients (n = 118) were randomized to each of three pacing modes in a crossover trial.Results Mode adherence was superior for dual-site RA (5.8 months) compared with SP (3.3 months; p < 0.001) and high RA pacing (4.7 months; p = 0.006). Adverse event-free survival improved with dual-site RA (p = 0.007 vs. SP) and was comparable to high RA (p = 0. 75). AF-free survival trended to improve with dual-site RA (hazard ratio [HR] 0.715, p = 0.07 vs. SP) but not high RA (HR = 0.71, p = 0.19) or when dual-site RA was compared with high RA (HR = 0.835, p = 0.175). Time-to-recurrence was longer in dual-site RA (1.77 months) compared with high RA (0.62 months, p < 0.09) or SP (0.44 months, p < 0.05). In antiarrhythmic drug-treated patients, dual-site RA reduced recurrence risk compared with SP (HR = 0.638, p = 0.011) and high RA (HR = 0.669, p = 0.06). In patients with < or =1 AF event/week, dual-site RA improved AF suppression (HR = 0.464, p = 0.004 vs. SP; HR = 0.623, p = 0.006 vs. high RA). Dual-site RA improved AF-free and mode survival (p < 0.03 vs. high RA, p < 0.001 vs. SP) and reduced asymptomatic AF (p < 0.01 vs. high RA).Conclusion Dual-site RA is safe and better tolerated than high RA and SP. In patients on antiarrhythmics, dual-site RA prolonged and high RA trended to prolong time-to-recurrent AF compared with SP. Dual-site RA provides superior symptomatic and asymptomatic AF prevention compared with high RA in patients with symptomatic AF frequency of < or =1/week.
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Such strategies (pacemaker addition) have never been prospectively investigated.
“Such strategies have never been prospectively investigated”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [839]
The existing populations studied for pacemaker addition in sick sinus syndrome are highly selected.
“the existing populations studied are highly selected.839,840”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [839]
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- Authors
- Saksena, S., Prakash, A., Ziegler, P., Hummel, J. D., Friedman, P., Plumb, V. J., Wyse, D. G., Johnson, E., Fitts, S., & Mehra, R.
- Affiliations
- Atlantic Health System (US)
- Medtronic (United States) (US)
- Mayo Clinic (US)
- University of Alabama at Birmingham (US)
- University of Calgary (CA)
- The Stern Cardiovascular Foundation (US)
- Corresponding author
- Saksena, Sanjeev
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2002-09
- Volume
- 40
- Issue
- 6
- Pages
- 1140-1150
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2150916657
- Cited by
- 171
- References
- 20
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 1 · 2023: 1 · 2022: 2 · 2021: 4 · 2020: 1 · 2019: 1 · 2018: 3 · 2017: 4 · 2016: 5 · 2015: 1 · 2014: 4 · 2013: 2 · 2012: 4
- FWCI
- 15.44
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College 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 › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- atrial fibrillation suppression, overdrive pacing, antiarrhythmic drugs, atrial fibrillation recurrence, bradycardia, atrial fibrillation prevention, asymptomatic atrial fibrillation, crossover trial
- MeSH terms
- Aged, Anti-Arrhythmia Agents, Atrial Fibrillation, Bradycardia, Cardiac Pacing, Artificial, Combined Modality Therapy, Female, Heart Atria, Humans, Male, Middle Aged, Prospective Studies, Time Factors, Cross-Over Studies, Secondary Prevention
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