Long-term outcomes of atrial antitachycardia pacing to prevent progression to permanent atrial fibrillation in patients implanted with pacemakers.

BACKGROUND

A second-generation atrial antitachycardia pacing (ATP), reactive ATP (rATP), was effective in preventing progression to permanent atrial fibrillation (AF) in patients with sick sinus syndrome (SSS) over a 2-year follow-up period. However, its long-term results and efficacy in patients with atrioventricular block (AVB) remain uncertain.

OBJECTIVE

This study aimed to evaluate the long-term efficacy of rATP in patients implanted with pacemakers owing to SSS and AVB.

METHODS

The incidence of progression to permanent AF was compared between 2 groups of the 349 patients implanted with dual-chamber pacemakers (134 with rATP function [rATP group] and 215 without rATP [control group]).

RESULTS

During the follow-up period (1906 ± 950 days), 57.5% of the patients in the rATP group and 55.3% in the control group experienced atrial tachyarrhythmia episodes lasting > 1 minute (P = .74). The incidence of progression to permanent AF was significantly lower in patients with SSS and AVB in the rATP group than in the control group (log-rank, SSS, P = .036; AVB, P = .029). Multivariable analysis showed that the use of rATP was a significant factor associated with a lower incidence of permanent AF progression. No severe complications related to rATP delivery were observed. Deliveries of ≥ 300 ATP sequences per month were associated with rapid battery drainage.

CONCLUSION

Progression to permanent AF was reduced by rATP in patients with SSS and AVB. Treatment efficacy and safety were sustained over 5 years. Clinical benefits and the risk of battery drainage should be balanced.