Abstract 17295: Effect of Atrial Rate-responsive Pacing in the Incidence of Sustained Atrial Arrhythmias in Patients With Implantable Cardioverter-defibrillators
Introduction: Atrial rate-responsive pacing (RRP) has proved to be safe in pacemaker recipients with chronotropic incompetence, but there is little data regarding its use in implantable cardioverter-defibrillator (ICD) patients.
Hypothesis: Atrial RRP may increase the occurrence of sustained atrial arrhythmias when programmed in ICD recipients.
Methods: Dual-chamber and triple-chamber ICD patients were included in this multicenter cohort study. Patients with permanent atrial fibrillation (AF) or VVI pacing mode were excluded. The number and duration of atrial tachycardia (AT)/AF episodes were assessed by remote monitoring.
Results: Data from 415 patients was collected after a 21.3±14.1 months follow-up. Atrial RRP was programmed in 90 (21.7%) patients and was associated to a higher atrial pacing percentage in the overall study population (51.2±33.8% versus 18.4±25.7%, P<0.001) and to a higher ventricular pacing percentage among dual-chamber devices (22.3±37.6% versus 9.3±25%, P 23 hours) were history of AF (odds ratio: 7.98; 95% confidence interval: 4.11-15.47; p<0,001) and atrial RRP (odds ratio: 3,58; 95% confidence interval: 1.82-7.03; p<0,001). RRP was related to a lower sustained AT/AF episodes-free survival both in patients with and without a history of AF (Figure). Within patients with a history of AF, atrial RRP was also associated with a higher median of AT/AF episodes/patient (18.5 [interquartile range: 339] versus 8 , P=0.016) and a higher percentage of time recording AT/AF (9.21% [36.32] versus 1.18% [16.31], P=0.024). Cumulative incidence of sustained AT/AF episodes > 23 hours was proportional to the atrial pacing percentages.
Conclusions: Atrial RRP in ICD patients was related to a higher cumulative incidence of sustained atrial arrhythmias >23 hours. This pacing mode seems to have an atrial proarrhythmic effect not described up to now in ICD patients, especially among those with a history of AF.
Author Disclosures: A. Fontenla: None. M. Lopez-Gil: None. J.B. Martinez-Ferrer: None. A. Rodriguez: None. J. Alzueta: None. E. Garcia: None. N. Basterra: None. R. Romero: None. J. Fernandez de la Concha: None. X. Viñolas: None. J. Villacastin: None. R. Salguero: None. F. Arribas: None.
- © 2015 by American Heart Association, Inc.