Atrial antitachycardia pacing and atrial remodeling: A substudy of the international, randomized MINERVA trial

Giuseppe Boriani, Raymond Tukkie, Mauro Biffi, Lluis Mont, Renato Ricci, Helmut Pürerfellner, Giovanni Luca Botto, Antonis S. Manolis, Maurizio Landolina, Michele Gulizia, J. Harrison Hudnall, Lorenza Mangoni, Andrea Grammatico, Luigi Padeletti, MINERVA Investigators

Research output: Contribution to journalArticle

Abstract

Background Atrial tachycardia (AT) and atrial fibrillation (AF) are common in pacemaker patients and are associated with bad prognoses. Objective The purpose of this study was to evaluate atrial antitachycardia pacing impact on AT/AF–induced atrial remodeling, measured by early recurrence of AT/AF (ERAF) and by change in left atrial diameter (LAD), and to evaluate the impact of AT/AF duration on ERAF incidence. Methods Pacemaker patients were randomized to dual-chamber pacing (Control DDDR: 385 patients), managed ventricular pacing (MVP: 398 patients), or atrial antitachycardia pacing plus MVP (DDDRP+MVP: 383 patients). LAD change, estimated by echocardiography, was considered significant if the relative difference between baseline and 24-month measurements was >10%. Results At median follow-up of 34 months, ERAF incidence was significantly lower in the DDDRP+MVP arm for all AT/AF durations, in particular, ERAF followed AT/AF longer than 3 hours in 53% cases in Control DDDR, in 51% cases in MVP, and in 39% cases in DDDRP+MVP (P <.001 vs other groups). ERAF incidence showed a U-shaped pattern when evaluated as a function of previous AT/AF duration, decreasing for durations from 5 minutes to 12 hours and increasing for longer durations. Among patients with significant LAD change, the proportion of patients with a reduction in LAD was 35% in Control DDDR, 37% in MVP, and 70% in DDDRP+MVP (P <.05 vs other groups). Conclusion Our data suggest that atrial electrical remodeling becomes important after about 12 hours of continuous arrhythmia. Compared to DDDR or MVP, DDDRP+MVP reduces ERAF and favors LAD reduction, suggesting that atrial antitachycardia pacing may reverse electrical and mechanical remodeling.

Original languageEnglish
Pages (from-to)1476-1484
Number of pages9
JournalHeart Rhythm
Volume14
Issue number10
DOIs
Publication statusPublished - Oct 1 2017

Keywords

  • Atrial antitachycardia pacing
  • Atrial fibrillation
  • Atrial fibrillation early recurrence
  • Atrial reverse remodeling
  • Left atrial diameter
  • Pacemaker
  • Reactive antitachycardia pacing

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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  • Cite this

    Boriani, G., Tukkie, R., Biffi, M., Mont, L., Ricci, R., Pürerfellner, H., Botto, G. L., Manolis, A. S., Landolina, M., Gulizia, M., Hudnall, J. H., Mangoni, L., Grammatico, A., Padeletti, L., & MINERVA Investigators (2017). Atrial antitachycardia pacing and atrial remodeling: A substudy of the international, randomized MINERVA trial. Heart Rhythm, 14(10), 1476-1484. https://doi.org/10.1016/j.hrthm.2017.05.023