High atrial antitachycardia pacing therapy efficacy is associated with a reduction in atrial tachyarrhythmia burden in a subset of patients with sinus node dysfunction and paroxysmal atrial fibriltation

BACKGROUND Atrial tachycardia (AT) and atrial flutter that occur in association with paroxysmal atrial fibrillation (AF) can be successfully terminated by antitachycardia pacing (ATP) therapy. We hypothesized that atrial ATP therapy reduces AT/AF burden in a subset of patients with symptomatic bradycardia and frequent paroxysmal AT/AF. OBJECTIVES This study evaluated the effect of atrial ATP therapy on AT/AF burden in a pacemaker population with paroxysmal AF. METHODS We compared AT/AF burden in 261 patients who received a Medtronic AT500 pacemaker for treatment of AT/AF in the setting of symptomatic bradycardia based on device-classified atrial ATP efficacy <60% and >= 60%. Patients with >= 10 device-detected episodes of AT/AF before and after atrial ATP therapy initiation were identified from four clinical studies performed in 72 centers worldwide. RESULTS The high efficacy group comprised 75 patients with atrial ATP efficacy >= 60%. The low efficacy group comprised 186 patients with atrial ATP efficacy <60%. AT/AF episode frequency was similar in both groups prior to ATP activation and decreased in the low efficacy group following ATP activation. Following atrial ATP initiation, total AT/AF burden increased slightly in the low ATP efficacy group (median 2.77 [25th -75th percentiles 0.84-5.86] hours/day vs 2.92 [0.59-8.12] hours/ day, P =.01). In contrast, total AT/AF burden decreased significantly in the high efficacy group (median 2.46 [0.29-8.88] hours/day vs 0.68 [0.13-2.97] hours/day, P <.001). CONCLUSION Up to 30% of patients with frequent episodes of paroxysmal AF and symptomatic bradycardia experience a reduction in AT/AF burden from atrial ATP therapy over time.