Abstract 17719: Competitive Atrial Pacing is an Important Risk Factor for Occurrence of Atrial Fibrillation in Paced Patients: Analysis of RATE Registry Data
During pacemaker (PMR) or defibrillator (ICD) follow-up, atrial tachycardia or atrial fibrillation (AT/AF) of various durations is often documented by device electrograms (EGM). However, inasmuch as certain device algorithms may cause competitive atrial pacing (CAP) resulting from: internal sensor triggered pacing, retrograde VA conduction or combination of refractory periods, we hypothesized that CAP would be associated with AT/AF events, and could even initiate AT/AF due to atrial pacing early after a P wave.
Methods: The RATE registry, a multicenter observational study of device patients (pts) (2238 ICDs and 3142 PMRs) followed between 2007 and 2012, was designed to evaluate the clinical implications of device detected AT/AF. In a randomly chosen subset of RATE pts, every EGM during 20± 6.6 months of follow-up was adjudicated by both a physician and a clinical engineer. Pts were considered “positive” for a diagnosis if ANY EGM during follow up documented that diagnosis, and negative if NO EGM documented that diagnosis. Two forms of CAP were defined: repetitive non-reentrant ventriculo-atrial synchrony (RNRVAS) and closely coupled atrial pacing after a P wave falling within PVARP, but not meeting criteria for RNRVAS, termed “ARAP.”
Results: A total of 15,989 EGMs were adjudicated in 584 pts (241 PMRs, 343 ICDs). Diagnosis frequencies are shown in Table. Statistically significant association between AT/AF and CAP was found (Chi-Square, Probability; 4.3, .039; 6.6, .01; and 5.9, .015; for RNRVAS, ARAP, and any CAP, respectively). Induction of AT/AF by CAP with capture was documented in multiple EGMs.
Conclusions: CAP is common in device pts. There is a strong association between various forms of CAP and AT/AF events during device follow-up. CAP is one of the mechanisms of AT/AF initiation in device pts.
- Atrial fibrillation
- Triggering mechanisms
- Atrial arrhythmias
- Implantable cardioconvert defibrillator
- © 2012 by American Heart Association, Inc.