Atrial antitachycardia pacing and managed ventricular pacing in bradycardia patients with paroxysmal or persistent atrial tachyarrhythmias: the MINERVA randomized multicentre international trial

Abstract

AimsAtrial fibrillation (AF) is a common comorbidity in bradycardia patients. Advanced pacemakers feature atrial preventive pacing and atrial antitachycardia pacing (DDDRP) and managed ventricular pacing (MVP), which minimizes unnecessary right ventricular pacing. We evaluated whether DDDRP and MVP might reduce mortality, morbidity, or progression to permanent AF when compared with standard dual-chamber pacing (Control DDDR).Methods and resultsIn a randomized, parallel, single-blind, multi-centre trial we enrolled 1300 patients with bradycardia and previous atrial tachyarrhythmias, in whom a DDDRP pacemaker had recently been implanted. History of permanent AF and third-degree atrioventricular block were exclusion criteria. After a 1-month run-in period, 1166 eligible patients, aged 74 ± 9 years, 50% females, were randomized to Control DDDR, DDDRP + MVP, or MVP. Analysis was intention-to-treat.The primary outcome, i.e. the 2-year incidence of a combined endpoint composed of death, cardiovascular hospitalizations, or permanent AF, occurred in 102/385 (26.5%) Control DDDR patients, in 76/383 (19.8%) DDDRP + MVP patients [hazard ratio (HR) = 0.74, 95% confidence interval 0.55–0.99, P = 0.04 vs. Control DDDR] and in 85/398 (21.4%) MVP patients (HR = 0.89, 95% confidence interval 0.77–1.03, P = 0.125 vs. Control DDDR). When compared with Control DDDR, DDDRP + MVP reduced the risk for AF longer than 1 day (HR = 0.66, 95% CI 0.52–0.85, P < 0.001), AF longer than 7 days (HR = 0.52, 95% CI 0.36–0.73, P < 0.001), and permanent AF (HR = 0.39, 95% CI 0.21–0.75, P = 0.004).ConclusionIn patients with bradycardia and atrial tachyarrhythmias, DDDRP + MVP is superior to standard dual-chamber pacing. The primary endpoint was significantly lowered through the reduction of the progression of atrial tachyarrhythmias to permanent AF.ClinicalTrials.gov IdentifierNCT00262119.

2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing

“…The authors stated that "patients were enrolled upon elective replacement of the device, and were healthy enough to survive the first device without experiencing a significant decrease in LV function." MINERVA, randomized multicenter (2014) [47] 1300 (PM) AF burden: no superiority of MVP pacing compared with the DDDR mode (AV/ PV delay 4180/210 ms in greater than 60% of patients, 53% of RV pacing). MVP in combination with atrial antitachycardia pacing was superior to both DDDR and MVP-only.…”

Effects of enhanced pacing modalities on health care resource utilization and costs in bradycardia patients: An analysis of the randomized MINERVA trial

“…21 In brief, the MINERVA trial is a multicenter, randomized, single-blind, controlled trial involving 63 cardiology centers in 15 countries (centers are listed in the Online Supplemental Appendix).…”

“…In particular, permanent AF was significantly lower (61% risk reduction) in bradycardia patients with the new pacing algorithm (DDDRP þ MVP) than in those with standard dual-chamber pacing (DDDR). 21 As a consequence, AF-related hospitalizations and emergency department (ED) visits were significantly reduced.…”

Current possibilities of permanent pacing for prevention of atrial fibrillation and heart failure progression

“…Снижение смертности, частоты развития постоянной формы ФП, госпитализаций по поводу сер-дечно-сосудистых осложнений (ОР 0,74, 95% ДИ 0,55-0,99; p=0,04) наблюдалось лишь в группе пациентов, ко-торым активировали сразу три группы алгоритмов. Не было выявлено различий в достижении комбинированно-го первичного исхода (смерть, госпитализации по поводу сердечно-сосудистых осложнений, развитие постоянной формы ФП) при применении только алгоритма по умень-шению правожелудочковой стимуляции по сравнению со стандартной двухкамерной стимуляцией (ОР 0,89, 95% ДИ 0,77-1,03; p=0,125) [3,7].…”