Document Detail


Effectiveness of rapid atrial pacing for termination of drug refractory atrial fibrillation: results of a dual chamber implantable cardioverter defibrillator trial.
MedLine Citation:
PMID:  15071249     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
There is increasing interest in the use of an implantable cardioverter defibrillator (ICD) to manage atrial tachyarrhythmias. Although device-based shock therapy is highly effective in terminating persistent atrial tachyarrhythmias, atrial overdrive pacing may also be useful, particularly when this therapy is applied early after the onset of an arrhythmia. A dual-chamber ICD (Medtronic 7250 Jewel AF(R)) has been studied in 267 patients with drug-refractory symptomatic AF. The patients were enrolled as part of multicenter clinical trial to evaluate the safety and efficacy of the device to manage atrial tachyarrhythmias in the absence of a standard ventricular ICD indication. The device discriminates atrial tachycardia (AT) from atrial fibrillation (AF) based on cycle length and regularity, and employs multiple methods of atrial overdrive pacing as well as shocks to terminate tachyarrhythmia episodes. Patients were followed for an average of 15.8 +/- 9.3 months. A majority (63%) of patients presented with a history of persistent AF and 34% presented with a history of paroxysmal AF. The pacing therapies terminated 54% of AT episodes and 27% of AF episodes. In patients with persistent AF, 75% of the AT/AF episodes that were successfully terminated by pacing lasted <or=9 minutes. When the pacing therapies failed, episodes lasted for several hours and 50% of the episodes received at least one shock. The results of this trial suggest that pace-termination plays an important role in device-based management of atrial tachyarrhythmias. It is estimated that early pace-termination of AT/AF episodes may reduce the need for device-based shocks among patients with persistent AF by about half.
Authors:
Michael R Gold; Robert B Leman; David E Euler
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Cardiac electrophysiology review     Volume:  7     ISSN:  1385-2264     ISO Abbreviation:  Card Electrophysiol Rev     Publication Date:  2003 Dec 
Date Detail:
Created Date:  2004-04-08     Completed Date:  2004-08-26     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  9708907     Medline TA:  Card Electrophysiol Rev     Country:  United States    
Other Details:
Languages:  eng     Pagination:  341-4     Citation Subset:  IM    
Affiliation:
Medical University of South Carolina, Charleston 29425, USA. goldmr@musc.edu
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MeSH Terms
Descriptor/Qualifier:
Algorithms
Atrial Fibrillation / drug therapy,  prevention & control,  therapy*
Cardiac Pacing, Artificial
Combined Modality Therapy
Defibrillators, Implantable*
Equipment Design
Humans
Tachycardia / prevention & control,  therapy*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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