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Reactive antitachycardia pacing therapy linked to lower AF progression rates
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Reactive antitachycardia pacing therapy was associated with lower atrial fibrillation progression rates in patients with pacemakers, defibrillators and resynchronization devices, according to a study presented at EHRA Europace-Cardiostim 2017.
“Reactive [atrial-based antitachycardia pacing] is a feature present in most Medtronic devices and it can be leveraged to improve patient care in patients with cardiac implantable devices who experience atrial tachycardia,” Giuseppe Boriani, MD, PhD, of the division of cardiology at the University of Modena and Reggio Emilia in Italy, told Cardiology Today. “Even if atrial antitachycardia is not directly capable of interrupting a pure AF episode, our studies show that AF episodes have moments when the atrial rhythm is slower or more regular, and that in these moments, reactive [atrial-based antitachycardia pacing] may terminate the arrhythmia episode and restore sinus rhythm.”
To evaluate the efficacy of reactive atrial-based antitachycardia pacing (Reactive ATP, Medtronic) in the prevention of AF progression, Boriani and colleagues used the Medtronic deidentified CareLink database.
The researchers evaluated device transmissions from pacemakers, defibrillators and resynchronization devices.
The control group had reactive atrial-based antitachycardia pacing disabled or not available for all transmissions, whereas the reactive atrial-based antitachycardia pacing cohort had therapy programmed on.
Using age, sex, device type, pacing mode, atrial tachycardia/AF (AT/AF) and percent ventricular pacing at baseline, the researchers were able to conduct 1:1 individual matching between the two sets of patients.
Event rates of patients with AT/AF at 2 years were estimated using the Kaplan-Meier method and HRs were calculated using Cox proportional hazard models.
A total of 51,252 patients qualified for the study. The reactive atrial-based antitachycardia pacing group consisted of 4,553 and matching resulted in 4,399 pairs. As a result, the total number of patients for analysis was 8,798.
There was a significantly lower risk for AT/AF events lasting at least 1 day (HR = 0.75), at least 7 days (HR = 0.62) and at least 30 days (HR = 0.57) for patients in the reactive atrial-based antitachycardia pacing group vs. the control group (P < .0001 for all).
The results were consistent regardless of age, sex, device type and baseline AT/AF.
“These data will improve trust in Reactive ATP therapy. This will be an important step in improving adoption of this effective therapy because in evidence-based medicine, both solid publications and health care providers’ self-experience are important,” Boriani said. “The study results represent the first-ever evidence of atrial antitachycardia pacing efficacy in [cardiac resynchronization therapy] and [implantable cardioverter defibrillator] patients.” – by Dave Quaile
References:
Boriani G, et al. Atrial fibrillation and ablation or devices: what do registries tell us? Presented at: EHRA Europace – Cardiostim 2017; June 18-21, 2017; Vienna.
Disclosure: Boriani reports no relevant financial disclosures.