Prospective Randomized Study to Assess the Efficacy of Site and Rate of Atrial Pacing on Long-Term Progression of Atrial Fibrillation in Sick Sinus Syndrome

Lau, Chu Pak; Ngarmukos, Tachapong; Wang, Chun Chieh; Wang, Jing Feng; Abe, Haruhiko; Kong, Chi Woon; Liew, Reginald; Shin, Dong Gu; Padeletti, Luigi; Kim, You Ho; Omar, Razali; Jirarojanakorn, Kreingkrai; Kim, Yoon Nyun; Chen, Mien Cheng; Sriratanasathavorn, Charn; Munawar, Muhammad; Kam, Ruth; Chen, Jan Yow; Cho, Yong Keun; Li, Yi Gang; Wu, Shu Lin; Bailleul, Christophe; Tse, Hung‐Fat

doi:10.1161/circulationaha.113.001644

Cited by 50 publications

(34 citation statements)

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“…4,6,30–32 Two recent trials, such as the ASSERT and the SAFE studies, did not find a substantial benefit of continuous atrial overdrive pacing in preventing AF occurrence. 4,30 However, it is important to note that both these studies tested only one prevention algorithm, while MINERVA trial tested three preventive algorithms together with aATP and MVP. Our interpretation of the positive results of MINERVA trial, compared with previous studies, is based on several considerations; first, previous studies might have been influenced by the detrimental effects induced by unnecessary ventricular stimulation, which in our trial was minimized by MVP algorithms.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2014

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2014

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“…87 Furthermore, atrial pacing from alternative atrial sites (septal vs. right atrial appendage) had no effect on progression of AF. 88 This reflects the fact that the AF…”

Section: Treatment Of Sndmentioning

confidence: 96%

Fibrosis, Electrics and Genetics

Morris

Kalman

2014

Circ J

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The sinoatrial node (SAN) is the normal pacemaker of the heart. During a human lifetime it must initiate approximately 2 billion heartbeats and coordinate the cardiovascular response to our physiological and emotional demands. Disease of the SAN is common, and one of the leading indications for electronic pacemaker implantation. Advances in understanding the genetics and molecular mechanisms determining normal SAN function, and of the pathways controlling remodeling are revealing SAN disease to be heterogeneous. We review the contemporary concepts of SAN function, heart rate adaptation and SAN disease from the molecular level to clinical application. (Circ J 2014; 78: 1272 -1282

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“…Currently, there is no risk stratification for SSS or CCD according to the genotype. 22 Clinically, both diseases develop at a later stage in life (around 70 years old), 41,42 and the consequences of developing SSS/CCD are not as devastating as the other sodium current disorders, such as BrS or LQT3. Pacemaker implantation is an established treatment in both diseases with a relatively low complication rate (excluding lead dislodgement), although patients are at risk of device infection or the development of heart failure.…”

Section: Sick Sinus Syndrome/cardiac Conduction Diseasementioning

confidence: 99%