Atrial overdrive pacing and incidence of heart failure-related adverse events in permanently paced patients

• Published in: Journal of interventional cardiac electrophysiology 2007-06, Vol.19 (1), p.55-60
• Main Authors: Schuchert, Andreas, Carlson, Mark, Ip, John, Messenger, John, Beau, Scott, Kalbfleisch, Steven, Gervais, Pierre, Cameron, Douglas A, Duran, Aurelio, Val-Mejias, Jesus, Mackall, Judith, Gold, Michael
• Format: Article
• Language: English
• Subjects: Aged; Algorithms; Atrial Fibrillation - therapy; Cardiac Output, Low - epidemiology; Cardiac Pacing, Artificial; Female; Humans; Incidence; Male; Pacemaker, Artificial; Prevalence; Single-Blind Method; Treatment Outcome
• ISSN: 1383-875X; 1572-8595
• DOI: 10.1007/s10840-007-9130-0

Atrial overdrive pacing algorithms may be effective in preventing or suppressing atrial fibrillation (AF). However, the maintenance of a heart rate incessantly faster than spontaneous could induce left ventricular (LV) dysfunction and promote heart failure (HF) on the long term. This post hoc analysis examined the effects of a new overdrive algorithm on the incidence of HF-related adverse events in 411 patients enrolled in the ADOPT-A trial. The AF Suppression algorithm was randomly programmed ON in 209 patients (treatment group) versus OFF in 202 patients (control group). The incidence of HF-related adverse events and HF-related deaths over a 6-month follow-up was compared between the two groups. Patients with versus without HF-related clinical events were also compared to each other within each group. There were eight HF-related adverse clinical events (3.8%) in the treatment group and 11 (5.4%) in the control group, including four HF-related deaths (1.9 vs. 2.0%) in each group during follow-up. Baseline NYHA functional class in patients with versus without HF-related adverse events was 1.4 +/- 0.5 versus 1.5 +/- 0.7 in the control, and 1.5 +/- 0.8 versus 1.5 +/- 0.6 in the treatment group. LV ejection fraction (EF) was 49 +/- 7% in patients with, versus 57 +/- 12% in patients without HF-related adverse events, in the control group, and 43 +/- 14% in patients with, versus 56 +/- 13% in patients without HF-related adverse events, in the treatment group. LVEF was lowest and similar in both groups among patients who died from HF (35 +/- 10% in the control and 38 +/- 27% in the treatment group). In ADOPT-A, HF-related clinical events and deaths were related to LV dysfunction and not to atrial pacing overdriven by the AF suppression algorithm.