A new pacemaker algorithm for the treatment of atrial fibrillation: results of the Atrial Dynamic Overdrive Pacing Trial (ADOPT)

• Published in: Journal of the American College of Cardiology 2003-08, Vol.42 (4), p.627-633
• Main Authors: Carlson, Mark D, 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; Aged, 80 and over; Algorithms; Atrial Fibrillation - therapy; Cardiac arrhythmia; Cardiac Pacing, Artificial - methods; Cardiology; Drug dosages; Female; Heart surgery; Humans; Male; Middle Aged; Mortality; Patients; Prospective Studies; Quality of life; Single-Blind Method; Sinuses; Substance abuse treatment; Treatment Outcome
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(03)00780-0

The Atrial Dynamic Overdrive Pacing Trial (ADOPT) was a single blind, randomized, controlled study to evaluate the efficacy and safety of the atrial fibrillation (AF) Suppression Algorithm (St. Jude Medical Cardiac Rhythm Management Division, Sylmar, California) in patients with sick sinus syndrome and AF. This algorithm increases the pacing rate when the native rhythm emerges and periodically reduces the rate to search for intrinsic atrial activity. Symptomatic AF burden (percentage of days during which symptomatic AF occurred) was the primary end point. Patients underwent pacemaker implantation, were randomized to DDDR with the algorithm on (treatment) or off (control), and were followed for six months. Baseline characteristics and antiarrhythmic drugs used were similar in both groups. The percentage of atrial pacing was higher in the treatment group (92.9% vs. 67.9%, p < 0.0001). The AF Suppression Algorithm reduced symptomatic AF burden by 25% (2.50% control vs. 1.87% treatment). Atrial fibrillation burden decreased progressively in both groups but was lower in the treatment group at each follow-up visit (one, three, and six months) (p = 0.005). Quality of life scores improved in both groups. The mean number of AF episodes (4.3 +/- 11.5 control vs. 3.2 +/- 8.6 treatment); total hospitalizations (17 control vs. 15 treatment); and incidence of complications, adverse events, and deaths were not statistically different between groups. The ADOPT demonstrated that overdrive atrial pacing with the AF Suppression Algorithm decreased symptomatic AF burden significantly in patients with sick sinus syndrome and AF. The decrease in relative AF burden was substantial (25%), although the absolute difference was small (2.50% control vs. 1.87% treatment).