Predictors of atrial antitachycardia pacing efficacy in patients affected by brady-tachy form of sick sinus syndrome and implanted with a DDDRP device.
Predictors of ATP efficacy in brady/tachy patients. BACKGROUND: Recent options
to treat atrial tachyarrhythmias (ATA) include implantable devices delivering
antitachycardia pacing therapies (ATP). No prospective study selected patients
with higher chances of episode termination by ATP or indicated the most
effective ATP use. Our aim was to study ATP efficacy in patients with
brady-tachy form of sinus node disease (SND), identifying clinical factors, ATA
characteristics, and device features predicting ATP efficacy. METHODS AND
RESULTS: Three hundred and sixteen patients (105 M, aged 71.1+/-8.8 years)
received a DDDRP pacemaker and were prospectively followed. Median follow-up was
18 months: 37,125 ATA episodes occurred in 217 patients; ATP treated 5,536 of
them. Overall, ATP efficacy was 50.0%. A multivariate analysis identified longer
arrhythmia cycle lengths (OR=1.25; CI=1.07-1.47) and shorter delays to ATP
delivery (OR=0.15; CI=0.10-0.22) as independent predictors of ATP efficacy for
episodes preceded by >or=5 minutes of sinus rhythm. Additionally, ATP efficacy
for all treated episodes was predicted by lower New York Heart Association
(NYHA) class (OR=0.64; CI=0.42-0.98), episode classification as nonimmediate
recurrence of ATA (non-IRAT) (OR=0.07; CI=0.02-0.33), absence of overlap in the
device detection windows (OR=0.54; CI=0.32-0.91), and flecainide treatment
(OR=2.22; CI=1.04-4.71). CONCLUSIONS: In patients paced for SND, multivariate
analysis shows that ATP efficacy is associated to longer arrhythmia cycle
lengths, shorter ATP delivery delays, NYHA class I, episode classification as
non-IRAT, absence of overlap in the atrial arrhythmia device detection windows,
and flecainide treatment
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