CLINICAL STUDY: ELECTROPHYSIOLOGY
Improved suppression of recurrent atrial fibrillation with dual-site right atrial pacing and antiarrhythmic drug therapy
Sanjeev Saksena, MD, FACC*,*,
Atul Prakash, MBBS, FACC*,
Paul Ziegler, MS#,
John D. Hummel, MD, FACC ,
Paul Friedman, MD, FACC ,
Vance J. Plumb, MD, FACC ,
D. George Wyse, MD, PhD, FACC||,
Eric Johnson, MD¶,
Stephanie Fitts, PhD#,
Rahul Mehra, PhD# DAPPAF Investigators
* Cardiovascular Institute, Atlantic Health System, Passaic, New Jersey, USA
Mid-Ohio Cardiology, Columbus, Ohio, USA
Cardiology Division, Mayo Clinic, Rochester, Minnesota, USA
Cardiology DivisionUniversity of Alabama, Birmingham, Alabama, USA
|| Cardiology Division, University of Calgary, Alberta, Canada
¶ The Stern Cardiovascular Center, Memphis, Tennessee, USA
# Medtronic, Inc., Minneapolis, Minnesota, USA
Manuscript received July 18, 2001;
revised manuscript received April 25, 2002,
accepted June 12, 2002.
* Reprint requests and correspondence: Dr. Sanjeev Saksena, Cardiovascular Institute, Atlantic Health System (Passaic), 350 Boulevard, Passaic, New Jersey 07055, USA.
CMENJ{at}aol.com
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  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).
CONCLUSIONS: 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 1/week.
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Abbreviations and Acronyms
| | AF | | atrial fibrillation | | DAPPAF | | Dual-Site Atrial Pacing for Prevention of Atrial Fibrillation | | RA | | right atrial |
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