Reactive atrial-based antitachycardia pacing significantly reduced the risk of atrial tachyarrhythmia events lasting ≥1 day by 19% (HR 0.81) compared to control in patients with cardiac devices.
Cohort (n=8,032)
Sí
Does reactive atrial-based antitachycardia pacing (rATP) reduce atrial tachyarrhythmia/atrial fibrillation events in patients with pacemakers, defibrillators, or resynchronization devices?
In a real-world matched cohort, enabling reactive atrial-based antitachycardia pacing significantly reduced the risk of prolonged atrial tachyarrhythmia/atrial fibrillation events.
Estimación del efecto: HR 0.81 (95% CI 0.74-0.88)
Tasa de eventos absoluta: 38.4% vs 43%
valor p: p=<0.0001
BACKGROUND: Reactive atrial-based antitachycardia pacing (rATP) aims to terminate atrial tachyarrhythmia/atrial fibrillation (AT/AF) episodes when they spontaneously organize to atrial flutter or atrial tachycardia; however, its effectiveness in the real-world has not been studied. We used a large device database (Medtronic CareLink, Medtronic, Minneapolis, MN, USA) to evaluate the effects of rATP at reducing AT/AF. METHODS: Pacemaker, defibrillator, and resynchronization device transmission data were analyzed. Eligible patients had device detected AT/AF during a baseline period but were not in persistent AT/AF immediately preceding first transmission. Note that 1:1 individual matching between groups was conducted using age, sex, device type, pacing mode, AT/AF, and percent ventricular pacing at baseline. Risks of AT/AF events were compared between patients with rATP-enabled versus control patients with rATP-disabled or not available in the device. For matched patients, AT/AF event rates at 2 years were estimated by Kaplan-Meier method, and hazard ratios (HRs) were calculated by Cox proportional hazard models. RESULTS: Of 43,440 qualifying patients, 4,203 had rATP on. Matching resulted in 4,016 pairs, totaling 8,032 patients for analysis. The rATP group experienced significantly lower risks of AT/AF events lasting ≥1 day (HR 0.81), ≥7 days (HR 0.64), and ≥30 days (HR 0.56) compared to control (P < 0.0001 for all). In subgroup analysis, rATP was associated with reduced risks of AT/AF events across age, sex, device type, baseline AT/AF, and preventive atrial pacing. CONCLUSIONS: Among real-world patients from a large device database, rATP therapy was significantly associated with a reduced risk of AT/AF. This association was independent of whether the patient had a pacemaker, defibrillator, or resynchronization device.
Crossley et al. (Fri,) conducted a cohort in Atrial tachyarrhythmia/atrial fibrillation (AT/AF) (n=8,032). Reactive atrial-based antitachycardia pacing (rATP) vs. rATP disabled or not available was evaluated on Time to first AT/AF event lasting ≥1 day (HR 0.81, 95% CI 0.74-0.88, p=<0.0001). Reactive atrial-based antitachycardia pacing significantly reduced the risk of atrial tachyarrhythmia events lasting ≥1 day by 19% (HR 0.81) compared to control in patients with cardiac devices.