Efficacy of Pacing Therapies for Treating Atrial Tachyarrhythmias in Patients With Ventricular Arrhythmias Receiving a Dual-Chamber Implantable Cardioverter Defibrillator

Abstract

for the Worldwide Jewel AF Investigators Background-Although overdrive pacing for treating atrial flutter is well established, the efficacy of device-based atrial pacing for treating spontaneous atrial tachyarrhythmias in patients with implantable cardioverter defibrillators (ICD) is unknown. This study evaluated the efficacy of novel pacing therapies for treating atrial tachyarrhythmias in patients receiving a dual-chamber ICD to treat ventricular tachyarrhythmias. Methods and Results-A Jewel AF ICD was implanted in 537 patients with ventricular arrhythmia who were followed for 11.4Ϯ8.2 months (74% had a documented history of atrial tachyarrhythmias). The device discriminated atrial tachycardia (AT) from atrial fibrillation (AF) on the basis of cycle length and regularity, and it used 3 different methods of overdrive atrial pacing (Ramp, Burstϩ, and 50-Hz burst) to treat AT episodes and one method (50-Hz burst) to treat AF episodes. Pacing successfully terminated 59% of 1500 spontaneous AT episodes in 127 patients and 30% of 880 AF episodes in 101 patients (PϽ0.001). With AT and AF episodes combined, pacing efficacy was 48%. Pacing efficacy was significantly reduced at AT cycle lengths Յ220 ms and AF cycle lengths Յ160 ms (PϽ0.01) The median time from pacing to AT/AF termination was 1.1 minute for the pacing successes and 96 minutes for the failures (PϽ0.001). Conclusions-Atrial

ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

“…High-rate atrial antitachycardia pacing may induce (transient) AF. Efficacy of advanced atrial pacing or cardioversion therapies varies greatly in function of episode duration, atrial cycle length, and atrial tachycardia mechanism (1013,1019,1020). Acute efficacy of atrial antitachycardia pacing may be as high as 40% (1013).…”

Device-based therapies for atrial fibrillation

“…Pacing therapies are more effective for device defined ATs (slower, more regular) than AF. Pacing terminated 59% of AT episodes but only 30% of AF episodes in one series [53]. Atrial pacing in conjunction with atrial defibrillation has been very effective in keeping highly selected patients in sinus rhythm at 1 year [54].…”

Implanted Devices and Atrial Fibrillation

“…being as low as 29% if the cycle length is 190 ms and as high as 65% when the cycle length is > 320 ms [45]. Also, atrial ATP is more effective if delivered in recent-onset AF paroxysms.…”