CLINICAL RESEARCH: CLINICAL TRIAL
A new pacemaker algorithm for the treatment of atrial fibrillation
Results of the Atrial Dynamic Overdrive Pacing Trial (ADOPT)
Mark D. Carlson, MD, MA*,*,
John Ip, MD ,
John Messenger, MD ,
Scott Beau, MD ,
Steven Kalbfleisch, MD||,
Pierre Gervais, MD¶,
Douglas A. Cameron, MD#,
Aurelio Duran, MD**,
Jesus Val-Mejias, MD,
Judith Mackall, MD*,
Michael Gold, MD, PhD ADOPT Investigators
* Department of Medicine, Case Western Reserve University Medical School and University Hospitals of Cleveland, Cleveland, Ohio, USA
Thoracic Cardiovascular Institute, Lansing, Michigan, USA
Long Beach Memorial Medical Center, Long Beach, California, USA
Arkansas Heart Hospital, Little Rock, Arkansas, USA
|| Mid Ohio Cardiology, Columbus, Ohio, USA
¶ Hospital St. Joseph, Trois-Rivieres, Canada
# Toronto General Hospital, Toronto, Canada
** Orlando Heart Center, Orlando, Florida, USA
St. Francis ICT, Wichita, Kansas, USA
Medical University of South Carolina, Charleston, South Carolina, USA
Manuscript received January 3, 2003;
revised manuscript received February 24, 2003,
accepted March 12, 2003.
* Reprint requests and correspondence: Dr. Mark D. Carlson, Department of Medicine, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, Ohio, USA 44106.
mdc2{at}po.cwru.edu
OBJECTIVES: The Atrial Dynamic Overdrive Pacing Trial (ADOPT) was a single blind, randomized, controlled study to evaluate the efficacy and safety of the atrial fibrillation (AF) Suppression Algorithm (St. Jude Medical Cardiac Rhythm Management Division, Sylmar, California) in patients with sick sinus syndrome and AF.
BACKGROUND: This algorithm increases the pacing rate when the native rhythm emerges and periodically reduces the rate to search for intrinsic atrial activity.
METHODS: Symptomatic AF burden (percentage of days during which symptomatic AF occurred) was the primary end point. Patients underwent pacemaker implantation, were randomized to DDDR with the algorithm on (treatment) or off (control), and were followed for six months.
RESULTS: Baseline characteristics and antiarrhythmic drugs used were similar in both groups. The percentage of atrial pacing was higher in the treatment group (92.9% vs. 67.9%, p < 0.0001). The AF Suppression Algorithm reduced symptomatic AF burden by 25% (2.50% control vs. 1.87% treatment). Atrial fibrillation burden decreased progressively in both groups but was lower in the treatment group at each follow-up visit (one, three, and six months) (p = 0.005). Quality of life scores improved in both groups. The mean number of AF episodes (4.3 ± 11.5 control vs. 3.2 ± 8.6 treatment); total hospitalizations (17 control vs. 15 treatment); and incidence of complications, adverse events, and deaths were not statistically different between groups.
CONCLUSIONS: The ADOPT demonstrated that overdrive atrial pacing with the AF Suppression Algorithm decreased symptomatic AF burden significantly in patients with sick sinus syndrome and AF. The decrease in relative AF burden was substantial (25%), although the absolute difference was small (2.50% control vs. 1.87% treatment).
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Abbreviations and Acronyms
| | ADOPT | | Atrial Dynamic Overdrive Pacing Trial | | AF | | atrial fibrillation | | ECG | | electrocardiogram | | LRO | | lower rate overdrive | | URO | | upper rate overdrive |
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