CLINICAL STUDY
Prevalence, characteristics and clinical implications of regular atrial tachyarrhythmias in patients with atrial fibrillation: insights from a study using a new implantable device
Carsten W. Israel, MD*,
Joachim R. Ehrlich, MD*,
Gerian Grönefeld, MD*,
Armin Klesius, MD*,
Thomas Lawo, MDb,
Bernd Lemke, MDb and
Stefan H. Hohnloser, MD, FACC, FESC*
* Department of Medicine, Division of Cardiology, J. W. Goethe University, Frankfurt, Germany
b the Department of Medicine, Division of Cardiology, Ruhr-University Bochum, Bergmannsheil, Bochum, Germany
Manuscript received September 14, 2000;
revised manuscript received April 5, 2001,
accepted April 11, 2001.
Reprint requests and correspondence: Dr. Stefan H. Hohnloser, Department of Medicine, Division of Cardiology, J. W. Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
Hohnloser{at}em.uni-frankfurt.de
OBJECTIVES
This study prospectively analyzed atrial tachyarrhythmia (AT) organization and antitachycardia pacing (ATP) success in patients with an implanted device for AT therapy.
BACKGROUND
In patients with atrial fibrillation (AF), the incidence of regular, slow ATs amendable by ATP is unknown.
METHODS
Forty patients with previously documented AT (70% with AF) received a new pacemaker with atrial electrogram (AEG) storage and atrial ATP capabilities for standard pacing indications. The AEGs acquired during the first month (study phase 1) were classified into high (type I), intermediate (type II) and low (type III) degrees of organization. Atrial ATP was then activated, and treated AT episodes were retrieved three and six months after implantation (study phase 2).
RESULTS
Of 824 AEGs retrieved before ATP activation (study phase 1), 351 (43%) were classified as type I, 47% as type II and 10% as type III. Episodes of AT starting as type I (35%) and type II or III (65%) maintained their type over 1 min in 73%. All patients with an exclusive history of AF also showed type I AEGs. In 361 subsequently treated AT episodes (study phase 2), ATP was successful in 62% of type I and 34% of type II episodes, but not in type III (p < 0.0001).
CONCLUSIONS
The majority of patients with a history of AF show not only disorganized but also highly organized AT episodes, which can be successfully terminated by ATP.
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Abbreviations and Acronyms
| | AEG | = atrial electrogram | | AF | = atrial fibrillation | | AT | = atrial tachyarrhythmia | | ATP | = antitachycardia pacing | | AV | = atrioventricular | | CI | = confidence interval | | GEE | = Generalized Estimating Equation |
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