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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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“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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Metadata
- 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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