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.
|
Abbreviations and Acronyms
| | AEG | = atrial electrogram | | AF | = atrial fibrillation | | AT | = atrial tachyarrhythmia | | ATP | = antitachycardia pacing | | AV | = atrioventricular | | CI | = confidence interval | | GEE | = Generalized Estimating Equation |
|
This article has been cited by other articles:
|
|
|
|
 
A. M. Gillis, M. Morck, D. V. Exner, R. S. Sheldon, H. J. Duff, B. L. Mitchell, and G. D. Wyse
Impact of atrial antitachycardia pacing and atrial pace prevention therapies on atrial fibrillation burden over long-term follow-up
Europace,
August 1, 2009;
11(8):
1041 - 1047.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. M. Gillis, M. Morck, D. V. Exner, A. Soo, M. S. Rose, R. S. Sheldon, H. J. Duff, K. M. Kavanagh, L. B. Mitchell, and D. G. Wyse
Beneficial effects of statin therapy for prevention of atrial fibrillation following DDDR pacemaker implantation
Eur. Heart J.,
August 1, 2008;
29(15):
1873 - 1880.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Mont, R. Ruiz-Granell, J. G. Martinez, J. R. Carmona, M. Fidalgo, E. Cobo, M. Riera, X. Navarro, and on behalf of the Prevention or Termination (POT) S
Impact of anti-tachycardia pacing on atrial fibrillation burden when added on top of preventive pacing algorithms: results of the prevention or termination (POT) trial
Europace,
January 1, 2008;
10(1):
28 - 34.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Gradaus, K. Seidl, T. Korte, E. Himmrich, H. Wieneke, A. Schuchert, W. Bauer, J. Gerss, C. G. Wollmann, M. Borggrefe, et al.
Reduction of ventricular tachyarrhythmia by treatment of atrial fibrillation in ICD patients with dual-chamber implantable cardioverter/defibrillators capable of atrial therapy delivery: the REVERT-AF Study
Europace,
July 1, 2007;
9(7):
534 - 539.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Gulizia, S. Mangiameli, S. Orazi, G. Chiaranda, G. Boriani, G. Piccione, N. DiGiovanni, A. Colletti, C. Puntrello, G. Butera, et al.
Randomized comparison between Ramp and Burst+ atrial antitachycardia pacing therapies in patients suffering from sinus node disease and atrial fibrillation and implanted with a DDDRP device
Europace,
July 1, 2006;
8(7):
465 - 473.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Azzolini, G. Critelli, V. De Giorgi, G. B. Del Giudice, G. Ibba, D. Melissano, A. Scaccia, and A. Puglisi
Atrial tachyarrhythmia burden modelling by some electrophysiological parameters in pacemaker-recipient patients with Brady-Tachy syndrome
Europace,
July 1, 2006;
8(7):
474 - 481.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Kadish and M. Mehra
Heart Failure Devices: Implantable Cardioverter-Defibrillators and Biventricular Pacing Therapy
Circulation,
June 21, 2005;
111(24):
3327 - 3335.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Padeletti, M. Santini, G. Boriani, G. Botto, A. Capucci, M. Gulizia, R. Ricci, A. Spampinato, P. Pieragnoli, E. Warman, et al.
Temporal variability of atrial tachyarrhythmia burden in bradycardia-tachycardia syndrome patients
Eur. Heart J.,
January 2, 2005;
26(2):
165 - 172.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Vollmann, E. Kollet, L. Lüthje, S. Busse, and C. Unterberg
Comparison of immediate and delayed automatic antitachycardia pacing for the termination of atrial tachyarrhythmias
Europace,
January 1, 2005;
7(3):
248 - 254.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Walker, S. C. Siu, S. Woods, D. A. Cameron, G. D. Webb, and L. Harris
Long-Term outcomes of cardiac pacing in adults with congenital heart disease
J. Am. Coll. Cardiol.,
May 19, 2004;
43(10):
1894 - 1901.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. R.J. Mitchell and N. Sulke
How do atrial pacing algorithms prevent atrial arrhythmias?
Europace,
January 1, 2004;
6(4):
351 - 362.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Puglisi, G. Altamura, F. Capestro, B. Castaldi, G. Critelli, S. Favale, L. Pavia, and G. Pettinati
Impact of Closed-Loop Stimulation, overdrive pacing, DDDR pacing mode on atrial tachyarrhythmia burden in Brady-Tachy Syndrome: A randomized study
Eur. Heart J.,
November 1, 2003;
24(21):
1952 - 1961.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. A. Lee, R. Weachter, S. Pollak, M. S. Kremers, A. M. Naik, R. Silverman, J. Tuzi, W. Wang, L. J. Johnson, D. E. Euler, et al.
The effect of atrial pacing therapies on atrial tachyarrhythmia burden and frequency: Results of a randomized trial in patients with bradycardia and atrial tachyarrhythmias
J. Am. Coll. Cardiol.,
June 4, 2003;
41(11):
1926 - 1932.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Hügl, C. W. Israel, C. Unterberg, T. Lawo, J. C. Geller, I. M. Kennis, D. E. Euler, J. L. Koehler, D. A. Hettrick, and on behalf of the AT500 Verification Study Investig
Incremental programming of atrial anti-tachycardia pacing therapies in bradycardia-indicated patients: effects on therapy efficacy and atrial tachyarrhythmia burden
Europace,
January 1, 2003;
5(4):
403 - 409.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. M. Gillis, C. Unterberg-Buchwald, H. Schmidinger, S. Massimo, K. Wolfe, D. J. Kavaney, M. F. Otterness, S. H. Hohnloser, and GEM III AT Worldwide Investigators
Safety and efficacy of advanced atrial pacing therapies for atrial tachyarrhythmias in patients with a new implantable dual chamber cardioverter-defibrillator
J. Am. Coll. Cardiol.,
November 6, 2002;
40(9):
1653 - 1659.
[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. Nattel
Therapeutic implications of atrial fibrillation mechanisms: can mechanistic insights be used to improve AF management?
Cardiovasc Res,
May 1, 2002;
54(2):
347 - 360.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
