Abstract 17953: Atrial Antitachycardia Pacing and Managed Ventricular Pacing Reduce Long-Lasting AF and AF Burden Compared to Conventional Dual-Chamber Pacing In Bradycardia Patients: Analysis of Minerva Randomized Trial Secondary Endpoints
Introduction: Atrial tachyarrhythmias (AT/AF) are common comorbidities in patients suffering from bradycardia. High technology pacemakers feature a comprehensive armamentarium to treat AT/AF, comprising atrial antitachycardia pacing (aATP), atrial prevention pacing (aPP) and Managed Ventricular Pacing (MVP), an algorithm which promotes intrinsic atrioventricular conduction to minimize right ventricular pacing detrimental effects.
Hypothesis: This analysis of the MINERVA trial secondary endpoints assessed the hypothesis that MVP+aATP+aPP reduce long-lasting AT/AF recurrences and AT/AF burden in pacemaker patients.
Methods: In a randomized parallel multi-center international trial we compared three pacing modalities: dual chamber pacing (DDD(R)), MVP and MVP+aATP+aPP. Randomization was 1:1:1. We included patients with pacemakers for any brady indication and having AT/AF history. We excluded patients with permanent complete AV block or permanent AT/AF. Patients were blinded to the randomized pacing mode. Device diagnostics allowed quantification of the 2-year incidence of AT/AF longer than pre-specified cumulative daily durations: 5 minutes, 1 hour, 6 hours, 1 day, 2 days, 7 days and 30 days. Kaplan-Meier survival method and Cox regression analysis were used to compare AT/AF incidence in the study arms, according to an intention-to-treat analysis. AT/AF burden was defined as the percentage of time in AT/AF.
Results: We randomized 1166 patients, aged 74±9 years, 588 (50%) males, to DDD(R) (N=385), MVP (N=398) or MVP+aATP+aPP (N=383). All randomized patients were included in the analyses. MVP+aATP+aPP significantly reduced the 2-year incidence of long-lasting AT/AF, (i.e. AT/AF longer than 1 day, 2, 7 and 30 days) compared to both DDD(R) and MVP arms. In particular the 2-year incidence of AT/AF >1 day was 31% in the MVP+aATP+aPP arm vs 42% in the DDD(R) arm (34% relative risk reduction - hazard ratio 0.66, 95% confidence interval 0.52-0.85, p=0.001). MVP+aATP+aPP significantly reduced AT/AF burden (median 0.3%, mean 8±13% in the MVP+aATP+aPP arm vs median 1.2%, mean 13±23% in the DDD(R) arm, p=0.002).
Conclusions: In conclusion, MVP+aATP+aPP reduced long-lasting AT/AF incidence and AT/AF burden in pacemaker patients with AT/AF history.
- © 2013 by American Heart Association, Inc.