Document Detail

Atrial fibrillation in recipients of cardiac resynchronization therapy device: 1-year results of the randomized MASCOT trial.
MedLine Citation:
PMID:  18760135     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Atrial fibrillation (AF) is associated with increased morbidity and mortality in patients suffering from heart failure (HF). Patients in New York Heart Association HF classes III or IV, with systolic dysfunction and a wide QRS, are candidates for cardiac resynchronization therapy (CRT), and might benefit from atrial overdrive pacing (AOP). METHODS: The Management of Atrial fibrillation Suppression in AF-HF COmorbidity Therapy (MASCOT) trial enrolled 409 CRT device recipients (79% men), who were randomly assigned to AOP ON (n = 197), versus AOP OFF (n = 197) and followed up for 1 year. Their mean age was 68 +/- 10 years, left ventricular ejection fraction 25 +/- 6%, QRS duration 163 +/- 29 milliseconds. New York Heart Association class III was present in 86% of patients and 19% had a history of paroxysmal AF. The primary study end point was incidence of permanent AF at 1 year. RESULTS: Atrial overdrive pacing increased the percentage of atrial pacing from 30% to 80% (P < .0001), was well tolerated, and did not interfere with (a) delivery of CRT (95% mean ventricular pacing in both groups), (b) response to CRT (70% responders in the control vs 67% in the treatment group), or (c) cardiac function (left ventricular ejection fraction increased from 24.5% +/- 6.2% to 32.7% +/- 10.9% in the control and from 25.8% +/- 6.8% to 33.1% +/- 12.6% in the treatment group). The incidence of permanent AF was 3.3% in both groups. By logistic regression analysis, a history of AF (P < .001) and absence of antiarrhythmic drugs (P = .002) were associated with permanent AF. CONCLUSIONS: In this first trial of a specific AF prevention algorithm in CRT recipients, AOP was safe and did not worsen HF. The prevention algorithm did not lower the 1-year incidence of AF.
Luigi Padeletti; Carmine Muto; Themistoclis Maounis; Andreas Schuchert; Maria-Grazia Bongiorni; Robert Frank; Thomas Vesterlund; Johannes Brachmann; Alfredo Vicentini; Gaël Jauvert; Giorgio Tadeo; Daniel Gras; Francesco Lisi; Antonio Dello Russo; Jean-Luc Rey; Eric Boulogne; Giuseppe Ricciardi;
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2008-07-07
Journal Detail:
Title:  American heart journal     Volume:  156     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2008-09-01     Completed Date:  2008-09-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  520-6     Citation Subset:  AIM; IM    
Ospedale Careggi, Florence, Italy.
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MeSH Terms
Atrial Fibrillation / epidemiology,  mortality,  prevention & control*
Atrial Function
Cardiac Pacing, Artificial / adverse effects,  methods*
Follow-Up Studies
Heart Failure / mortality,  therapy*
Middle Aged
Pacemaker, Artificial*
Prostheses and Implants
Single-Blind Method
Stroke Volume
Treatment Outcome
Ventricular Function
Fiorenzo Acquati / ; Francesco Alessandrini / ; Maria-Grazia Bongiorni / ; Johannes Brachmann / ; Valeria Calvi / ; Ngai-yin Chan / ; Per Dahl Christensen / ; Pierre Fiorello / ; Daniel Flammang / ; Francesco Foti / ; Robert Frank / ; Antonio Fusco / ; Grahame Goode / ; Daniel Gras / ; Michael Gruska / ; Gael Jauvert / ; Salem Kachboura / ; Gert Kaltofen / ; Wolfgang Kiowski / ; Francesco Lisi / ; Themistoclis Maounis / ; Eraldo Occhetta / ; Luigi Padeletti / ; Olivier Piot / ; Jean-Ernst Poulard / ; Jean-Luc Rey / ; Nadir Saoudi / ; Andreas Schuchert / ; Olivier Thomas / ; Bernardo Tuccillo / ; Thomas Vesterlund / ; Paul Vock / ; Arnd Weide / ; Paolo Zecchi /

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