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Individualized Selection of Pacing Algorithms for the Prevention of Recurrent Atrial Fibrillation: Results from the VIP Registry
Author(s) -
LEWALTER THORSTEN,
YANG ALEXANDER,
PFEIFFER DIETRICH,
RUITER JAAP,
SCHNITZLER GÖTZ,
MARKERT TILMANN,
ASKLUND MOGENS,
PRZIBILLE OLIVER,
WELZ ARMIN,
ESMAILZADEH BAHMAN,
LINHART MARKUS,
LÜDERITZ BERNDT
Publication year - 2006
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2006.00305.x
Subject(s) - medicine , atrial fibrillation , algorithm , cardiology , computer science
Objectives: The VIP registry investigated the efficacy of preventive pacing algorithm selection in reducing atrial fibrillation (AF) burden.Background: There are few data identifying which patients might benefit most from which preventive pacing algorithms.Methods: Patients, with at least one documented AF episode and a conventional antibradycardia indication for pacemaker therapy, were enrolled. They received pacemakers with AF diagnostics and four preventive algorithms (Selection and PreventAF series, Vitatron). A 3‐month Diagnostic Phase with conventional pacing identified a Substrate Group (>70% of AF episodes with <2 premature atrial contractions [PACs] before AF onset) and a Trigger Group (≤70% of AF episodes with <2 PACs before AF onset). This was followed by a 3‐month Therapeutic Phase where in the Trigger Group algorithms were enabled aimed at avoiding or preventing a PAC and in the Substrate Group continuous atrial overdrive pacing was enabled.Results: One hundred and twenty‐six patients were evaluated. In the Trigger Group (n = 73), there was a statistically significant 28% improvement in AF burden (median AF burden: 2.06 hours/day, Diagnostic Phase vs 1.49 hours/day, Therapy Phase; P = 0.03304 signed‐rank test), and reduced PAC activity. There was no significant improvement in AF burden in the Substrate Group (median AF burden: 1.82 hours/day, Diagnostic Phase vs 2.38 hours/day, Therapy Phase; P = 0.12095 signed‐rank test), and little change in PAC activity.Conclusions: We identified a subgroup of patients for whom the selection of appropriate pacing algorithms, based on individual diagnostic data, translated into a reduced AF burden. Trigger AF patients were more likely responders to preventive pacing algorithms as a result of PAC suppression.