New-generation atrial antitachycardia pacing (Reactive ATP) is associated with reduced risk of persistent or permanent atrial fibrillation in patients with bradycardia: Results from the MINERVA randomized multicenter international trial

Luigi Padeletti, Helmut Pürerfellner, Lluis Mont, Raymond Tukkie, Antonis S. Manolis, Renato Ricci, Giuseppe Inama, Paolo Serra, Mike G. Scheffer, Vitor Martins, Eduardo N. Warman, Marco Vimercati, Andrea Grammatico, Giuseppe Boriani

Research output: Contribution to journalArticle

Abstract

Background Atrial fibrillation (AF) is a frequent comorbidity in patients with pacemaker and is a recognized cause of mortality, morbidity, and quality-of-life impairment. The international MINimizE Right Ventricular pacing to prevent Atrial fibrillation and heart failure trial established that atrial preventive pacing and atrial antitachycardia pacing (DDDRP) in combination with managed ventricular pacing (MVP) reduce permanent AF occurrence in comparison with standard dual-chamber pacing (DDDR). Objective We aimed to determine the role of new-generation atrial antitachycardia pacing (Reactive ATP) in preventing AF disease progression. Methods Patients with dual-chamber pacemaker and with previous atrial tachyarrhythmias were randomly assigned to DDDR (n = 385 (33%)), MVP (n = 398 (34%)), or DDDRP+MVP (n = 383 (33%)) group. The incidence of permanent AF, as defined by the study investigator, or persistent AF, defined as ≥7 consecutive days with AF, was estimated using the Kaplan-Meier method, while its association with patients' characteristics was evaluated via multivariable Cox regression. Results At 2 years, the incidence of permanent or persistent AF was 26% (95% confidence interval [CI] 22%-31%) in the DDDR group, 25% (95% CI 21%-30%) in the MVP group, and 15% (95% CI 12%-20%) in the DDDRP+MVP group (P 44.4%) as a significant predictor of reduced permanent or persistent AF risk (hazard ratio 0.32; 95% CI 0.13-0.781; P =.012) and episodes' characteristics, such as long atrial arrhythmia cycle length, regularity, and the number of rhythm transitions, as predictors of high ATP efficacy. Conclusion In patients with bradycardia, DDDRP+MVP delays AF disease progression, with Reactive ATP efficacy being an independent predictor of permanent or persistent AF reduction.

Original languageEnglish
Pages (from-to)1717-1725
Number of pages9
JournalHeart Rhythm
Volume12
Issue number8
DOIs
Publication statusPublished - Aug 1 2015

Keywords

  • Antitachycardia pacing
  • Atrial fibrillation
  • Pacemaker
  • Reactive ATP

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Padeletti, L., Pürerfellner, H., Mont, L., Tukkie, R., Manolis, A. S., Ricci, R., Inama, G., Serra, P., Scheffer, M. G., Martins, V., Warman, E. N., Vimercati, M., Grammatico, A., & Boriani, G. (2015). New-generation atrial antitachycardia pacing (Reactive ATP) is associated with reduced risk of persistent or permanent atrial fibrillation in patients with bradycardia: Results from the MINERVA randomized multicenter international trial. Heart Rhythm, 12(8), 1717-1725. https://doi.org/10.1016/j.hrthm.2015.04.015