Renato Ricci, Paolo Azzolini,
Andrea Puglisi, Carlo Pignalberi*, Andrea Spampinato*, Fulvio Bellocci*, Giuseppe
Boriani**, Alessandro Capucci***, Sergio Cavaglia°, Maria Teresa Laudadio°, Francesco De
Seta°.
Fatebenefratelli Hospital, Rome, *Villa Tiberia Hospital, Rome, **Policlinico S.
Orsola, Bologna, ***Civile Hospital, Piacenza, °Medtronic Italia spa, Rome, Italy
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A consistent atrial pacing (CAP) algorithm has been
designed to achieve a high percentage of atrial pacing (AP) as a means to suppress
paroxysmal atrial fibrillation (PAF). This software can be placed in the pacemaker via
telemetry using a custom research telemetry device. The CAP algorithm monitors beat by
beat spontaneous atrial activity and continuously updates atrial escape interval (AEI) to
overdrive suppress it. We downloaded CAP algorithm for 24 hours into the pulse generator
of 15 patients, (3 M,12 F), mean age 71 ± 7 y, affected by sinus node disease,
chronotropic incompetence and recurrent PAF, implanted with Medtronic Thera DR 7940 device
with bipolar atrial leads. Eight pts were paced in DDD + CAP, 7 pts in DDDR + CAP.
Simultaneous Holter monitoring was recorded. Data collected have been matched with 24-hour
Holter monitoring in conventional DDD and DDDR mode.
Results.
TABLE I
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DDD + CAP
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HOLTER DDD
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HOLTER DDDR
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PAF/day
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0.1±0.3
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2.0±2.1
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10.0±29.0
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% AP
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94±7
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79±18
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82±26
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PAC/beats per day (%)
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0.5±0.9
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1.0±2.5
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0.2±0.2
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Lower rate
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60±0
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72±3
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72±3
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Max rate
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109±11
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81±8
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107±12
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TABLE II
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DDDR + CAP
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HOLTER DDD
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HOLTER DDDR
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PAF/day
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0
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1.1±1.3
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21.0±41.0
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% AP
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97±2
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61±23
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90±11
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PAC/beats per day (%)
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0.1±0.1
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1.2±2.9
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0.2±0.2
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Lower rate
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60±0
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71±2
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71±2
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Max rate
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112±13
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86±21
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110±17
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PAC = Premature atrial complexes.
Only one patient experienced one PAF episode during CAP + DDD pacing. Two pts reported
very slight palpitations at rest in the late afternoon.
Conclusions. CAP algorithm working was consistent with its technical
design in suppressing both premature atrial beats and spontaneous sinus rhythm. AP
percentage was higher than that in DDD and DDDR in spite of a lower basic rate. Patient
tolerance was good. Large long-term randomized clinical studies are needed to evaluate the
clinical efficacy of CAP in suppressing PAF.
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