Effect of PR interval and pacing mode on persistent atrial fibrillation incidence in dual chamber pacemaker patients: a sub-study of the international randomized MINERVA trial
Key result
MVP reduced persistent AF in short PR patients (HR 0.58; P=0.047), while standard DDDR pacing reduced AF in long PR patients (HR 0.65; P=0.049), showing a significant interaction (P=0.012).
Why the study?
To evaluate whether PR interval can guide the choice between standard DDDR pacing and managed ventricular pacing (MVP) in dual-chamber pacemaker patients.
Does pacing mode selection based on PR interval reduce the incidence of persistent atrial fibrillation in dual chamber pacemaker patients?
Population
906 dual-chamber pacemaker patients with available data from the MINERVA trial
Comparison
Control DDDR vs MVP vs DDDRP + MVP according to PR interval
Design
Sub-study of an international randomized trial
Authors
Discussion
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Implication
PR-guided MVP or DDDR selection may reduce persistent AF; extends RCT evidence for personalized pacing in dual-chamber pacemaker patients.
Study Design
Type
RCT (n=906)
Multicenter
Yes
Structured PICO
Does pacing mode selection based on PR interval reduce the incidence of persistent atrial fibrillation in dual chamber pacemaker patients?
P
Population
906 dual chamber pacemaker patients from the international randomized MINERVA trial analyzed for the interaction between PR interval and pacing mode on atrial fibrillation risk.
I
Intervention
Managed ventricular pacing (MVP) or atrial anti-tachycardia pacing plus MVP (DDDRP + MVP)
C
Comparator
Control DDDR mode
O
Outcome
Incidence of atrial fibrillation (AF) longer than 7 consecutive dayshard clinical
Main Result
Hazard Ratio: 0.58 (95% CI 0.34–0.99)
p-value: p=0.047
PR interval can guide optimal pacing mode selection, with short PR patients benefiting from MVP and long PR patients benefiting from standard DDDR to reduce persistent AF.
Cite This Study
Boriani et al. (2018) conducted an RCT in Dual chamber pacemaker patients (n=906). Managed ventricular pacing (MVP) vs. Standard DDDR pacing was evaluated on Atrial fibrillation (AF) longer than 7 consecutive days (HR 0.58, 95% CI 0.34-0.99, p=0.047). MVP reduced persistent AF in short PR patients (HR 0.58; P=0.047), while standard DDDR pacing reduced AF in long PR patients (HR 0.65; P=0.049), showing a significant interaction (P=0.012).