Copyright © 2003 by the European Society of Cardiology.
Clinical research
Impact of Closed-Loop Stimulation, overdrive pacing, DDDR pacing mode on atrial tachyarrhythmia burden in Brady-Tachy Syndrome
A randomized study
a Cardiology Division, S. Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
b Cardiology Division, S. Giacomo Hospital, Rome, Italy
c Lancisi Cardiology Hospital, Ancona, Italy
d Cardiology Division, Veneziale Hospital, Isernia, Italy
e II Cardiology chair, Cardiovascular Disease, ‘La Sapienza’ University, Rome, Italy
f Arrhythmia Serv.-Cardiosurgery, Dep. Emergency and Transplant, University of Bari, Bari, Italy
g Cardiology Division, Piemonte Hospital, Messina, Italy
h Cardiology Division, Ferrari Hospital, Casarano, Italy
* Corresponding author. Dr A. Puglisi, S. Giovanni Calibita Fatebenefratelli Hospital, Cardiology, Isola Tiberina, Rome 00186, Italy. Tel.: +39-06-6837348; fax: +39-06-5913257
Received 19 May 2003; revised 21 July 2003; accepted 28 August 2003
Abstract
Aims Atrial overdrive pacing algorithms increase Atrial Pacing Percentage (APP) to reduce Atrial Tachyarrhythmia (AT) recurrences in patients with Brady-Tachy Syndrome (BTS). This study aimed to compare AT burden and APP in BTS patients treated with conventional DDDR pacing, DDD+ overdrive or Closed-Loop Stimulation (CLS).
Methods and results One hundred and forty-nine BTS patients were included (72 male, mean age 74±9), who received a dual chamber pacemaker (Philos DR or Inos 2+CLS, Biotronik GmbH, Berlin, Germany) programmed in DDD at 70min–1. At 1-month follow-up, DDDR, DDD+ or CLS algorithms were activated according to randomization. Follow-up visits for data collection were performed at 4 and 7 months. Non parametric statistical tests (Kruskal–Wallis H-test, Dunn test, Spearman coefficient) were used to analyse not-normally-distributed samples. At 7 months, AT burden was significantly lower in CLS group (20.3±63.1min/day, P<0.01) compared to DDDR (56.0±184.0min/day) and DDD+ group (63.1±113.8min/day). APP was higher in CLS (89.0±13.2%) and in DDD+ group (97.9±2.7%) than in DDDR group (71.1±26.7%, P<0.001). The correlation found between AT burden and APP was very weak: at 7-month follow-up the Spearman coefficient was –0.29 (P=NS) in CLS, –0.52 (P<0.01) in DDD+, –0.22 (P=NS) in DDDR.
Conclusions CLS pacing was associated with a significantly lower AT burden,compared to the other pacing algorithms. Moreover APP was significantly higher in DDD+ and in CLS mode, than in DDDR. APP weakly correlated with AT burden only in DDD+ mode, though the lowest AT burden level was obtained in the CLS group where no significant correlation was found.
Key Words: Atrial tachyarrhythmiaburden • Brady-Tachy Syndrome • Atrial overdrive pacing • Atrial pacing percentage
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