CLINICAL RESEARCH: CLINICAL TRIAL
The effect of atrial pacing therapies on atrial tachyarrhythmia burden and frequency
Results of a randomized trial in patients with bradycardia and atrial tachyarrhythmias
Michael A. Lee, MD, FACC*,*,
Richard Weachter, MD, FACC ,
Scott Pollak, MD, FACC ,
Mark S. Kremers, MD, FACC ,
Ajay M. Naik, MD||,
Russell Silverman, MD, FACC¶,
Joann Tuzi, RN**,
Wayne Wang, MS**,
Linda J. Johnson, PhD**,
David E. Euler, PhD** ATTEST Investigators
* John Muir/Mount Diablo Medical Center, Walnut Creek, California, USA
Ferrell-Duncan Clinic and Cox Medical Center, Springfield, Missouri, USA
Florida Heart Institute and Florida Hospital, Orlando, Florida, USA
MidCarolina Cardiology and Presbyterian Hospital, Charlotte, North Carolina, USA
|| Cedar-Sinai Medical Center and UCLA School of Medicine, Los Angeles, California, USA
¶ St. Joseph’s Hospital Health Center, Syracuse, New York, USA
** Medtronic Inc., Minneapolis, Minnesota, USA
Manuscript received September 27, 2002;
revised manuscript received February 20, 2003,
accepted February 25, 2003.
* Reprint requests and correspondence: Dr. Michael A. Lee, 365 Hawthorne Avenue, #201, Oakland, California 94609, USA.
drmichaelalee{at}yahoo.com
OBJECTIVES: The Atrial Therapy Efficacy and Safety Trial (ATTEST) was a prospective, randomized study to evaluate preventive pacing and antitachycardia pacing (ATP) in patients with symptomatic atrial fibrillation (AF) or atrial tachycardia (AT).
BACKGROUND: The effect of the combination of atrial prevention and termination algorithms on AT/AF burden and frequency in pacemaker patients is unknown.
METHODS: A DDDRP pacemaker (AT500, Medtronic Inc., Minneapolis, Minnesota) with three atrial preventive pacing algorithms and two ATP algorithms was implanted in 368 patients. Patients were randomized one-month post-implant to all prevention and ATP therapies ON or OFF and followed for three months. The OFF group had DDDR pacing at a lower programmed rate of 60 ppm. The AT/AF burden and frequency were determined from daily device counters in 324 patients treated according to protocol.
RESULTS: In 17,018 episodes with stored electrograms, appropriate detection was confirmed in 17,004 (99.9%). The median percentage of atrial pacing was 98% in the ON group versus 75% in the OFF group (p < 0.001). Using device-defined criteria for successful termination, ATP terminated 8,590 (54%) of 15,789 treated episodes. The median AT/AF burden during the three-month study period was 4.2 h/month ON versus 1.1 h/month OFF (p = 0.20). The median AT/AF frequency was 1.3 episodes/month ON versus 1.2 episodes/month OFF (p = 0.65). System-related, complication-free survival at four months was 90.2% (Kaplan-Meier estimate).
CONCLUSIONS: This DDDRP pacemaker is safe, has accurate AT/AF detection, and provides ATP with 54% efficacy as defined by the device. The atrial prevention and termination therapies combined did not reduce AT/AF burden or frequency in this patient population.
|
Abbreviations and Acronyms
| | A:V | | atrial:ventricular | | AF | | atrial fibrillation | | AT | | atrial tachycardia | | ATP | | antitachycardia pacing | | GEE | | generalized estimating equation |
|
This article has been cited by other articles:
|
|
|
|
 
H. Ghanbari, M. Robinson, J. Ottino, C. Machado, and M. Daccarett
Pro-arrhythmia in atrial fibrillation suppression pacing algorithms
Europace,
October 6, 2009;
(2009)
eup311v1.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. N. Simantirakis, E. G. Arkolaki, and P. E. Vardas
Novel pacing algorithms: do they represent a beneficial proposition for patients, physicians, and the health care system?
Europace,
October 1, 2009;
11(10):
1272 - 1280.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
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]
|
|
|
|
|
|
|
H. Purerfellner, L. Urban, G. de Weerd, J. Ruiter, J. Brandt, A. Havlicek, B. Hugl, J. Widdershoven, L. Kornet, and R. Kessels
Reduction of atrial fibrillation burden by atrial overdrive pacing: experience with an improved algorithm to reduce early recurrences of atrial fibrillation
Europace,
January 1, 2009;
11(1):
62 - 69.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. J. Camm, P. Kirchhof, G. Y.H. Lip, I. Savelieva, and S. Ernst
CHAPTER 29 Atrial Fibrillation
ESC Textbook of Cardiovascular Medicine,
January 1, 2009;
2(1):
med-9780199566990-chapter - med-9780199566990-chapter.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. M. Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, D. L. Hayes, et al.
ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons
J. Am. Coll. Cardiol.,
May 27, 2008;
51(21):
e1 - e62.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Writing Committee Members, A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. M. Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, et al.
ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons
Circulation,
May 27, 2008;
117(21):
e350 - e408.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. E.W. Hemels, J. H. Ruiter, G. P. Molhoek, N. J.G.M. Veeger, A. C.P. Wiesfeld, A. V. Ranchor, M. van Trigt, A. Pilmeyer, I. C. Van Gelder, and for The Features in AT500TM study; Chances for pat
Right atrial preventive and antitachycardia pacing for prevention of paroxysmal atrial fibrillation in patients without bradycardia: a randomized study
Europace,
March 1, 2008;
10(3):
306 - 313.
[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]
|
|
|
|
|
|
|
C. W. Israel
Studying atrial fibrillation: what can we learn from the AFTherapy study?
Europace,
December 1, 2007;
9(12):
1107 - 1109.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A.J. Camm, N. Sulke, N. Edvardsson, P. Ritter, B.A. Albers, J.H. Ruiter, T. Lewalter, P.A. Capucci, E. Hoffmann, and on behalf of the AFTherapy investigators
Conventional and dedicated atrial overdrive pacing for the prevention of paroxysmal atrial fibrillation: the AFTherapy study
Europace,
December 1, 2007;
9(12):
1110 - 1118.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Padeletti, P. Pieragnoli, V. Jentzen, and A. Schuchert
The comorbidity of atrial fibrillation and heart failure: a challenge for electrical therapies
Eur. Heart J. Suppl.,
December 1, 2007;
9(suppl_I):
I81 - I86.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. W. Israel
What is the role of the pacing rate in the prevention of atrial tachyarrhythmias?
Europace,
November 1, 2007;
9(11):
999 - 1001.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. K. Kantharia, R. A. Freedman, D. Hoekenga, G. Tomassoni, S. Worley, R. Sorrentino, D. Steinhaus, J. M. Wolkowicz, Z. A. Syed, and and the AOP Study Investigators
Increased base rate of atrial pacing for prevention of atrial fibrillation after implantation of a dual-chamber pacemaker: insights from the Atrial Overdrive Pacing Study
Europace,
November 1, 2007;
9(11):
1024 - 1030.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Authors/Task Force Members, P. E. Vardas, A. Auricchio, J.-J. Blanc, J.-C. Daubert, H. Drexler, H. Ector, M. Gasparini, C. Linde, F. B. Morgado, et al.
Guidelines for cardiac pacing and cardiac resynchronization therapy: The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in Collaboration with the European Heart Rhythm Association
Europace,
October 1, 2007;
9(10):
959 - 998.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Authors/Task Force Members, P. E. Vardas, A. Auricchio, J.-J. Blanc, J.-C. Daubert, H. Drexler, H. Ector, M. Gasparini, C. Linde, F. B. Morgado, et al.
Guidelines for cardiac pacing and cardiac resynchronization therapy: The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in Collaboration with the European Heart Rhythm Association
Eur. Heart J.,
September 2, 2007;
28(18):
2256 - 2295.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Petrutiu, A. V. Sahakian, and S. Swiryn
Abrupt changes in fibrillatory wave characteristics at the termination of paroxysmal atrial fibrillation in humans
Europace,
July 1, 2007;
9(7):
466 - 470.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. Sulke, J. Silberbauer, L. Boodhoo, N. Freemantle, K. Kamalvand, S. O'Nunain, D. Hildick-Smith, G. W. Lloyd, N. R. Patel, and V. Paul
The use of atrial overdrive and ventricular rate stabilization pacing algorithms for the prevention and treatment of paroxysmal atrial fibrillation: the Pacemaker Atrial Fibrillation Suppression (PAFS) study
Europace,
June 11, 2007;
(2007)
eum111v1.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. H. Schoenfeld
Contemporary Pacemaker and Defibrillator Device Therapy: Challenges Confronting the General Cardiologist
Circulation,
February 6, 2007;
115(5):
638 - 653.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Writing Committee Members, V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, et al.
ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society
Europace,
September 1, 2006;
8(9):
651 - 745.
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al.
ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society
J. Am. Coll. Cardiol.,
August 15, 2006;
48(4):
e149 - e246.
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al.
ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society
Circulation,
August 15, 2006;
114(7):
e257 - e354.
[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]
|
|
|
|
|
|
|
F. Drago, M. S. Silvetti, G. Grutter, and A. De Santis
Long term management of atrial arrhythmias in young patients with sick sinus syndrome undergoing early operation to correct congenital heart disease
Europace,
July 1, 2006;
8(7):
488 - 494.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Hoffmann, N. Sulke, N. Edvardsson, J. Ruiter, T. Lewalter, A. Capucci, A. Schuchert, S. Janko, J. Camm, and on behalf of the Atrial Fibrillation Therapy (AFT)
New Insights Into the Initiation of Atrial Fibrillation: A Detailed Intraindividual and Interindividual Analysis of the Spontaneous Onset of Atrial Fibrillation Using New Diagnostic Pacemaker Features
Circulation,
April 25, 2006;
113(16):
1933 - 1941.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Gulizia, S. Mangiameli, G. Chiaranda, V. Spadola, N. Di Giovanni, A. Colletti, V. Bulla, A. Circo, O. Pensabene, L. Vasquez, et al.
Design and rationale of a randomized study to compare amiodarone and Class IC anti-arrhythmic drugs in terms of atrial fibrillation treatment efficacy in patients paced for sinus node disease: the PITAGORA trial.
Europace,
April 1, 2006;
8(4):
302 - 305.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. E.W. Hemels, A. C.P. Wiesfeld, B. Inberg, P. F.H.M. Van Dessel, W. Nieuwland, E. S. Tan, H. Mulder, D. J. Van Veldhuisen, and I. C. Van Gelder
Right atrial overdrive pacing for prevention of symptomatic refractory atrial fibrillation.
Europace,
February 1, 2006;
8(2):
107 - 112.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. Musilli and L. Padeletti
Pacemaker selection: time for a rethinking of complex pacing systems?
Eur. Heart J.,
January 2, 2006;
27(2):
132 - 135.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Capucci, M. Santini, L. Padeletti, M. Gulizia, G. Botto, G. Boriani, R. Ricci, S. Favale, F. Zolezzi, N. Di Belardino, et al.
Monitored Atrial Fibrillation Duration Predicts Arterial Embolic Events in Patients Suffering From Bradycardia and Atrial Fibrillation Implanted With Antitachycardia Pacemakers
J. Am. Coll. Cardiol.,
November 15, 2005;
46(10):
1913 - 1920.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. P. Knight, B. J. Gersh, M. D. Carlson, P. A. Friedman, R. L. McNamara, S. A. Strickberger, H. F. Tse, A. L. Waldo, and for the AHA Writing Group
Role of Permanent Pacing to Prevent Atrial Fibrillation: Science Advisory From the American Heart Association Council on Clinical Cardiology (Subcommittee on Electrocardiography and Arrhythmias) and the Quality of Care and Outcomes Research Interdisciplinary Working Group, in Collaboration With the Heart Rhythm Society
Circulation,
January 18, 2005;
111(2):
240 - 243.
[Abstract]
[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]
|
|
|
|
|
|
|
D. Flammang, V. Loteanu, D. Hamani, M. Lambiez, and G. Flammang-Dorie
Brady-tachy syndrome: Rapid atrial pacing efficacy in preventing atrial fibrillation recurrence assessed by reliable electrograms: the prefib pilot study
Europace,
January 1, 2005;
7(5):
482 - 489.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Zimetbaum and M. E. Josephson
Is There a Role for Maintaining Sinus Rhythm in Patients with Atrial Fibrillation?
Ann Intern Med,
November 2, 2004;
141(9):
720 - 726.
[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]
|
|
|
|
|
|
|
C. W. Israel
Is there a role for pacing in the prevention of atrial tachyarrhythmias?
Europace,
January 1, 2004;
6(5):
380 - 383.
[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]
|
|
|
|
|
|
|
A. Schuchert
Contributions of permanent cardiac pacing in the treatment of atrial fibrillation
Europace,
January 1, 2003;
5(s1):
S36 - S41.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
