14th International Congress
THE "NEW FRONTIERS"
OF ARRHYTHMIAS 2000

Jan. 29 - Feb. 5, 2000
Marilleva, Trento, Italy

RT-189

Assessment of a new pacing algorithm after atrioventricular junction ablation and DDDR pacemaker implantation for drug-refractory paroxysmal atrial fibrillation

Alessandro Proclemer, Luigi Padeletti*, Carlo Pappone**, Domenico Facchin, Patrizio Mazzone**, Francesco Maggi***, Carlo De Michele***, Tiziana Marotta***.
Istituto di Cardiologia, Fondazione IRCAB, Udine, *Istituto di Cardiologia, Universita di Firenze, **Dipartimentodi Cardiologia, Istituto San Raffaele, Milano, ***Medtronic, Inc., Italy

Abstract

BACKGROUND. Consistent atrial pacing (CAP) may reduce the incidence of paroxysmal atrial fibrillation (PAF) and development of chronic atrial fibrillation (AF) compared to standard DDDR pacing. Aim of this study is to assess the efficacy of CAP in patients with drug refractory PAF treated by AV junction (AVJ) radiofrequency ablation and DDDR pacemaker (PM) implantation.

METHODS. The study group included 21 patients, 10 males and 11 females, mean age 66±9 years; organic heart disease was present in 18 patients. Mean number of symptomatic PAF episodes per month before AVJ ablation was 7.4±7.1. All patients were successfully treated by AVJ ablation and implanted with Medtronic Thera DR 7960i PM connected to Medtronic Capsure SP atrial bipolar lead and Capsure SP ventricular unipolar lead. CAP dynamically selects a pacing rate just faster than the spontaneous sinus rate without affecting Thera-i mode-switch (MS). All the patients were assigned to a first two-month period of DDDR pacing+CAP activated (ON) or suspended (OFF), and to a second two months cross-over period of DDDR pacing+inverted CAP modality. At each follow-up (pre-procedure, two-month/CAP ON, 4-month/CAP OFF) we evaluated quality of life questionnaire (QOL- SSF36), number of MS episodes, number of symptomatic PAF episodes, mean episode duration, main symptoms scale.

RESULTS.

QOL index 1: energy index (low-high/1-10) QOL index 2: activity index (low-high/1-10).

CONCLUSIONS. Patients with PAF treated by AVJ ablation showed a high number of MS activation and duration. CAP did not change significantly neither the occurrence nor the duration of MS. Moreover, QOL indexes were similar in DDDR+CAP ON and in DDDR+CAP OFF mode. Further studies are requested to confirm these data.

Key Words