Impact of Closed-Loop Stimulation, overdrive pacing, DDDR pacing mode on atrial tachyarrhythmia burden in Brady-Tachy Syndrome. A randomized study.

Abstract

Atrial overdrive pacing algorithms increase Atrial Pacing Percentage (APP) to reduce Atrial Tachyarrhythmia (AT) recurrences in patients with Brady-Tachy Syndrome (BTS). This study aimed to compare AT burden and APP in BTS patients treated with conventional DDDR pacing, DDD+ overdrive or Closed-Loop Stimulation (CLS). One hundred and forty-nine BTS patients were included (72 male, mean age 74+/-9), who received a dual chamber pacemaker (Philos DR or Inos 2+CLS, Biotronik GmbH, Berlin, Germany) programmed in DDD at 70min(-1). At 1-month follow-up, DDDR, DDD+ or CLS algorithms were activated according to randomization. Follow-up visits for data collection were performed at 4 and 7 months. Non parametric statistical tests (Kruskal-Wallis H-test, Dunn test, Spearman coefficient) were used to analyse not-normally-distributed samples. At 7 months, AT burden was significantly lower in CLS group (20.3+/-63.1min/day, P<0.01) compared to DDDR (56.0+/-184.0min/day) and DDD+ group (63.1+/-113.8min/day). APP was higher in CLS (89.0+/-13.2%) and in DDD+ group (97.9+/-2.7%) than in DDDR group (71.1+/-26.7%, P<0.001). The correlation found between AT burden and APP was very weak: at 7-month follow-up the Spearman coefficient was -0.29 (P=NS) in CLS, -0.52 (P<0.01) in DDD+, -0.22 (P=NS) in DDDR. CLS pacing was associated with a significantly lower AT burden,compared to the other pacing algorithms. Moreover APP was significantly higher in DDD+ and in CLS mode, than in DDDR. APP weakly correlated with AT burden only in DDD+ mode, though the lowest AT burden level was obtained in the CLS group where no significant correlation was found.