Reduction of atrial fibrillation burden by atrial overdrive pacing: experience with an improved algorithm to reduce early recurrences of atrial fibrillation
Key result
Enhanced post-mode switch overdrive pacing did not significantly reduce median AT/AF episodes per day (1.19 vs 1.38) or AT/AF burden in the overall population.
Why the study?
Does temporary overdrive pacing at 90 bpm for 10 min starting just prior to AT/AF termination reduce AT/AF burden in patients with AT/AF?
Population
41 analyzed patients (45 enrolled) with atrial tachycardia/atrial fibrillation (AT/AF)
Comparison
Temporary overdrive pacing at 90 bpm for 10 min… vs Control period (crossover design)
Design
RCT, randomized, single blind
Authors
Discussion
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Implication
PMOP(enhanced) may reduce AT/AF episodes; leaves open whether it improves clinical outcomes in larger trials.
Key Points
- This study aims to assess the effectiveness of an enhanced atrial overdrive pacing algorithm in reducing atrial fibrillation burden among patients.
- Conducted a prospective, randomized, single blind, crossover trial with 45 enrolled patients.
- Compared the efficacy of standard post-mode switch overdrive pacing with an enhanced version (PMOP(enhanced)).
- Patients stratified by atrial fibrillation burden before enrollment and analyzed accordingly.
- No significant difference in AT/AF episodes per day or ERAF frequency among the overall population.
- Group B patients experienced a significant reduction in median AT/AF burden (3.71 vs. 1.71 hours, P = 0.02) during active pacing.
- Group A showed no change in AT/AF frequency or burden with the enhanced algorithm.
Study Design
Type
RCT (n=45)
Blinding
Single-blind
Randomization
randomized
Structured PICO
Does temporary overdrive pacing at 90 bpm for 10 min starting just prior to AT/AF termination reduce AT/AF burden in patients with AT/AF?
P
Population
45 patients with atrial tachycardia/atrial fibrillation enrolled in a crossover study evaluating an enhanced post-mode switch overdrive pacing algorithm.
I
Intervention
Temporary overdrive pacing at 90 bpm for 10 min starting just prior to device-classified AT/AF termination (PMOP(enhanced))
C
Comparator
Control period (crossover design)
O
Outcome
AT/AF burden (time per day spent in AT/AF), number of AT/AF episodes per day, and number of early recurrences of atrial fibrillation (ERAF) per daysurrogate
Main Result
Absolute Event Rate: 1.19% vs 1.38%
An enhanced post-mode switch overdrive pacing algorithm did not reduce overall AT/AF burden but significantly reduced it in a subgroup of patients with a high baseline frequency of early recurrences.
Cite This Study
Pürerfellner et al. (2008) conducted an RCT in Atrial tachycardia/atrial fibrillation (AT/AF) (n=45). Enhanced post-mode switch overdrive pacing (PMOP(enhanced)) vs. Control period was evaluated on Median number of AT/AF episodes per day. Enhanced post-mode switch overdrive pacing did not significantly reduce median AT/AF episodes per day (1.19 vs 1.38) or AT/AF burden in the overall population.