Key result
DDDRP + MVP cuts death, CV hospitalization, or permanent AF ~26% vs standard dual-chamber pacing.
Why the study?
Advanced pacemakers with atrial preventive pacing, atrial antitachycardia pacing, and managed ventricular pacing may reduce mortality, morbidity, or progression to permanent AF in bradycardia patients with atrial tachyarrhythmias compared to standard dual-chamber pacing.
Does DDDRP + MVP reduce the composite of death, cardiovascular hospitalizations, or permanent AF in patients with bradycardia and previous atrial tachyarrhythmias?
RCT (n=1,166)
single-blind
parallel
Yes
Does DDDRP + MVP reduce the composite of death, cardiovascular hospitalizations, or permanent AF in patients with bradycardia and previous atrial tachyarrhythmias?
In patients with bradycardia and atrial tachyarrhythmias, advanced pacemaker algorithms (DDDRP + MVP) significantly reduce the composite of death, cardiovascular hospitalizations, or permanent AF compared to standard dual-chamber pacing.
Answers are grounded in this paper and cite their sources.
Supports DDDRP + MVP over standard pacing to lower event risk in bradycardia with atrial tachyarrhythmias; extends RCT evidence for advanced algorithms.
AIMS: Atrial fibrillation (AF) is a common comorbidity in bradycardia patients. Advanced pacemakers feature atrial preventive pacing and atrial antitachycardia pacing (DDDRP) and managed ventricular pacing (MVP), which minimizes unnecessary right ventricular pacing. We evaluated whether DDDRP and MVP might reduce mortality, morbidity, or progression to permanent AF when compared with standard dual-chamber pacing (Control DDDR). METHODS AND RESULTS: In a randomized, parallel, single-blind, multi-centre trial we enrolled 1300 patients with bradycardia and previous atrial tachyarrhythmias, in whom a DDDRP pacemaker had recently been implanted. History of permanent AF and third-degree atrioventricular block were exclusion criteria. After a 1-month run-in period, 1166 eligible patients, aged 74 ± 9 years, 50% females, were randomized to Control DDDR, DDDRP + MVP, or MVP. Analysis was intention-to-treat. The primary outcome, i.e. the 2-year incidence of a combined endpoint composed of death, cardiovascular hospitalizations, or permanent AF, occurred in 102/385 (26.5%) Control DDDR patients, in 76/383 (19.8%) DDDRP + MVP patients [hazard ratio (HR) = 0.74, 95% confidence interval 0.55-0.99, P = 0.04 vs. Control DDDR] and in 85/398 (21.4%) MVP patients (HR = 0.89, 95% confidence interval 0.77-1.03, P = 0.125 vs. Control DDDR). When compared with Control DDDR, DDDRP + MVP reduced the risk for AF longer than 1 day (HR = 0.66, 95% CI 0.52-0.85, P < 0.001), AF longer than 7 days (HR = 0.52, 95% CI 0.36-0.73, P < 0.001), and permanent AF (HR = 0.39, 95% CI 0.21-0.75, P = 0.004). CONCLUSION: In patients with bradycardia and atrial tachyarrhythmias, DDDRP + MVP is superior to standard dual-chamber pacing. The primary endpoint was significantly lowered through the reduction of the progression of atrial tachyarrhythmias to permanent AF. CLINICALTRIALSGOV IDENTIFIER: NCT00262119.
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Boriani et al. (2014) conducted an RCT in bradycardia and previous atrial tachyarrhythmias (n=1,166). Atrial preventive pacing and atrial antitachycardia pacing (DDDRP) + managed ventricular pacing (MVP) vs. Standard dual-chamber pacing (Control DDDR) was evaluated on combined endpoint composed of death, cardiovascular hospitalizations, or permanent AF (HR 0.74, 95% CI 0.55-0.99, p=0.04). DDDRP + MVP reduced the 2-year risk of death, cardiovascular hospitalization, or permanent AF compared to standard dual-chamber pacing.
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