SIGNIFICANCE OF THE ALGORITHMS ON MINIMIZATION OF RIGHT-VENTRICULAR ELECTROSTIMULATION IN PREVENTION OF ATRIAL FIBRILLATION PROGRESSION IN PATIENTS WITH SICK SINUS SYNDROME

Aim. To assess the efficacy of algorithms for minimization of the rightventricular stimulation (MVS) for prevention of atrial fibrillation (AF) progression in patients with sick sinus node syndrome (SSS) and documented AF in anamnesis, comparing to standard bi-chamber electrical stimulation (DDDR).

Material and methods. The study was one-center, prospective, randomized trial with consequent 74 patients inclusion, who had indications to permanent DDDR due to SSS and AF in anamnesis. Patients were randomized to DDDR group (n=36) and active MVS (n=38) group. Procedure of electrocardiostimulator (ECS) maintenance was done at 6 months and 1 year. During follow-up visits, information was saved in the ECS memory, as the data on AF burden. Primary endpoints were AF burden and time to persistent AF onset.

Results. During the study, there were no significant differences in AF burden between the groups. Median of AF burden was 6,0 min/day (25- 75 percentiles: 0-42 min/day) in DDDR, and 6,0 min/day (25-75 perc.: 0-42 min/day; p=0,67) in MVS group. Persistent AF development was registered in 5 patients, of those 3 (8,6%) in DDDR and in 2 (5,3%) in MVS (HR 1,25; 95% CI 0,2-7,98; p=0,47). Medication or electrocardioversion was done for 9 (25,7%) patients from DDDR and 12 (31,6%) from MVS groups (HR 0,86, 95% CI 0,31-2,38, p=0,39).

Conclusion. There was no benefit of MVS algorithms in short term period in decrease of AF burden and in its progression prevention towards persistent AF in SSS patients with the anamnesis of paroxysmal AF, comparing to standard DDDR regimen of ECS.

1. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016; 37: 2893-962.

2. Chugh S, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation 2014; 129: 837-47.

3. Healey JS, Connolly SJ, Gold MR, et al. ASSERT Investigators. Subclinical atrial fibrillation and the risk of stroke. N Engl J Med 2012; 366: 120-9.

4. Healey JS, Toff WD, Lamas GA, et al. Cardiovascular outcomes with atrial-based pacing compared with ventricular pacing: meta-analysis of randomized trials, using individual patient data. Circulation 2006; 114: 11-7.

5. Brignole M, Auricchio A, Baron-Esquivias G, et al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. The Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J 2013; 34: 2281-329.

6. Nielsen JC, Thomsen PE, Højberg S, et al. DANPACE Investigators. A comparison of single-lead atrial pacing with dual-chamber pacing in sick sinus syndrome. Eur Heart J 2011; 32: 686-96.

7. Sweeney MO, Hellkamp AS, Ellenbogen KA, et al. Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation 2003; 107: 2932-7.

8. Sweeney MO, Bank AJ, Nsah E, et al. Search AV Extension and Managed Ventricular Pacing for Promoting Atrioventricular Conduction (SAVE PACe) Trial. Minimizing ventricular pacing to reduce atrial fibrillation in sinus-node disease. N Engl J Med 2007; 357: 1000-8.

9. Purerfellner H, Gillis AM, Holbrook R, et al. Accuracy of atrial tachyarrhythmia detection in implantable devices with arrhythmia therapies. Pacing Clin Electrophysiol 2004; 27: 983-92.

10. Boriani G, Tukkie R, Manolis AS, et al. Atrial antitachycardia pacing and managed ventricular pacing in bradycardia patients with paroxysmal or persistent atrial tachyarrhythmias: the MINERVA randomized multicentre international trial. Eur Heart J 2014; 35: 2352-62.

11. Boriani G, Glotzer TV, Santini M, et al. Device detected atrial fibrillation and risk for stroke: an analysis of more than 10,000 patients from the SOS AF project (Stroke Prevention Strategies based on Atrial Fibrillation information from implanted devices). Eur Heart J 2014; 35: 508-16.

12. Nielsen JC, Thomsen PE, Højberg S, et al. Atrial fibrillation in patients with sick sinus syndrome: the association with PQ-interval and percentage of ventricular pacing. Europace 2012; 14: 682-9.