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
View larger version (57K):
[in a new window]
|
Figure 1 (A) Freedom from crossover within 4.5 months of entering randomized treatment phase for each pacing mode. The percentage of patients surviving in the mode is tabulated on the Y-axis and the follow-up duration in the mode on the X-axis. Dual right atrial (RA) pacing shows a higher proportion of patients able to remain in the randomized treatment mode as compared with other modes. Dual, dual-site RA pacing; single, high RA pacing; support, demand pacing in atrium or ventricle at low support rate. (B) Freedom from all symptomatic atrial fibrillation (AF) in each randomized pacing mode in the entire study population. Dual RA pacing but not high RA pacing shows a trend to prolongation of time interval to AF recurrence.
|
|
View larger version (35K):
[in a new window]
|
Figure 2 Freedom from all symptomatic atrial fibrillation (AF) in each randomized pacing mode in study population receiving concomitant class 1 or 3 antiarrhythmic drugs (AAD+ on the left) or without concomitant drug therapy (AAD– on the right). Dual right atrial (RA) pacing but not high RA pacing shows prolongation of time interval to AF recurrence as compared with support pacing and a trend to prolongation as compared with high RA pacing in drug-treated patients. There is no difference in outcome in patients on any randomized pacing mode without concomitant drug therapy. AAD = antiarrhythmic drug.
|
|
View larger version (31K):
[in a new window]
|
Figure 3 Freedom from all symptomatic atrial fibrillation (AF) in each randomized pacing mode in study population receiving concomitant class 1 or 3 antiarrhythmic drugs with frequent (weekly events to two events in three months) AF at baseline. Dual right atrial (RA) pacing shows prolongation of time interval to AF recurrence as compared with high RA or support pacing in these patients.
|
|
View larger version (18K):
[in a new window]
|
Figure 4 Quality-of-life in the study population at baseline and in each randomized treatment mode for individual measures. Atrial fibrillation symptom checklist (paired analysis) in each randomized mode shows the benefits of both overdrive pacing modes as compared with support pacing.
|
|
View larger version (17K):
[in a new window]
|
Figure 5 Comparison of symptomatic or asymptomatic atrial fibrillation (AF) events meeting high rate atrial (HRA) event detection criteria in the dual-site right atrial (RA) pacing or high RA pacing arms of the study. Data are presented as mean values per day. A significant reduction in mean event frequency is observed for both AF end points in dual-site RA pacing arm as compared with the high RA pacing arm, suggesting benefit with respect to both symptomatic and symptomatic AF. MS = made switch.
|
|
|
