Improved suppression of recurrent atrial fibrillation with dual-site right atrial pacing and antiarrhythmic drug therapy

Sanjeev Saksena, Atul Prakash, Paul Ziegler, John D. Hummel, Paul Friedman, Vance J. Plumb, D. George Wyse, Eric Johnson, Stephanie Fitts, Rahul Mehra

Research output: Contribution to journalArticle

147 Scopus citations

Abstract

OBJECTIVES: We compared the safety, tolerance and effectiveness of overdrive high right atrial (RA), dual-site RA and support (DDI or VDI) pacing (SP) in patients with symptomatic atrial fibrillation (AF) and bradycardias. BACKGROUND: Optimal pacing methods for AF prevention remain unclear. METHODS: Patients (n = 118) were randomized to each of three pacing modes in a crossover trial. RESULTS: Mode adherence was superior for dual-site RA (5.8 months) compared with SP (3.3 months; p < 0.001) and high RA pacing (4.7 months; p = 0.006). Adverse event-free survival improved with dual-site RA (p = 0.007 vs. SP) and was comparable to high RA (p = 0.75). AF-free survival trended to improve with dual-site RA (hazard ratio [HR] 0.715, p = 0.07 vs. SP) but not high RA (HR = 0.71, p = 0.19) or when dual-site RA was compared with high RA (HR = 0.835, p = 0.175). Time-to-recurrence was longer in dual-site RA (1.77 months) compared with high RA (0.62 months, p < 0.09) or SP (0.44 months, p < 0.05). In antiarrhythmic drug-treated patients, dual-site RA reduced recurrence risk compared with SP (HR = 0.638, p = 0.011) and high RA (HR = 0.669, p = 0.06). In patients with ≤1 AF event/week, dual-site RA improved AF suppression (HR = 0.464, p = 0.004 vs. SP; HR = 0.623, p = 0.006 vs. high RA). Dual-site RA improved AF-free and mode survival (p < 0.03 vs. high RA, p < 0.001 vs. SP) and reduced asymptomatic AF (p < 0.01 vs. high RA). CONCLUSIONS: Dual-site RA is safe and better tolerated than high RA and SP. In patients on antiarrhythmics, dual-site RA prolonged and high RA trended to prolong time-to-recurrent AF compared with SP. Dual-site RA provides superior symptomatic and asymptomatic AF prevention compared with high RA in patients with symptomatic AF frequency of ≤1/week.

Original languageEnglish (US)
Pages (from-to)1140-1150
Number of pages11
JournalJournal of the American College of Cardiology
Volume40
Issue number6
DOIs
StatePublished - Sep 18 2002

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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