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J Am Coll Cardiol, 2003; 41:1926-1932, doi:10.1016/S0735-1097(03)00426-1 © 2003 by the American College of Cardiology Foundation |
* 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.
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