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Carberry T, Tsao S, Chaouki AS. Patient-activated Anti-tachycardia pacing in adult congenital heart disease. Pacing Clin Electrophysiol 2022; 45:711-716. [PMID: 35266171 PMCID: PMC9314925 DOI: 10.1111/pace.14475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/07/2022] [Accepted: 02/20/2022] [Indexed: 11/30/2022]
Abstract
Introduction In adults with congenital heart disease, intra‐atrial reentrant tachycardia (IART) is a common arrhythmia that causes significant morbidity and mortality. One treatment option for IART is antitachycardia pacing. Atrial antitachycardia pacing algorithms deliver therapy for IART with ≥2:1 conduction, but most algorithms will not recognize IART with 1:1 conduction. Temporary Patient Activated Rx (TPARx) is Medtronic software that can be installed in antitachycardia pacemakers allowing patients to deliver therapies on demand for IART with 1:1 conduction. Methods Retrospective chart review at a single institution of all patients who had TPARx installed into their pacemaker. Results Four adults with single ventricle congenital heart disease and IART underwent Fontan conversion, arrhythmia surgery, and placement of an epicardial dual‐chamber antitachycardia pacemaker. They had recurrent IART with a long cycle length and 1:1 conduction that failed to trigger antitachycardia pacing therapies. TPARx software was programmed into their pacemakers to allow recognition and treatment of IART with 1:1 conduction. Mean follow‐up duration after TPARx programming was 4.9 years. Each patient received at least one successful antitachycardia pacing therapy via TPARx – range 0.4–26 treated IART episodes per year. There were no atrial or ventricular arrhythmias induced with antitachycardia pacing. Two patients were able to discontinue anticoagulation after TPARx installation. Conclusion This series demonstrates the use of TPARx software as part of a long‐term IART management strategy in select patients with IART who have failed more conventional therapies.
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Affiliation(s)
- Thomas Carberry
- Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Chicago, IL, USA
| | - Sabrina Tsao
- Division of Cardiology, Hong Kong Children's Hospital, The University of Hong Kong, Shing Cheong Rd, Ngau Tau Kok, Hong Kong
| | - Ahmad Sami Chaouki
- Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Chicago, IL, USA
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Munawar DA, Mahajan R, Agbaedeng TA, Thiyagarajah A, Twomey DJ, Khokhar K, O'Shea C, Young GD, Roberts-Thomson KC, Munawar M, Lau DH, Sanders P. Implication of ventricular pacing burden and atrial pacing therapies on the progression of atrial fibrillation: A systematic review and meta-analysis of randomized controlled trials. Heart Rhythm 2019; 16:1204-1214. [PMID: 30772532 DOI: 10.1016/j.hrthm.2019.02.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is common after pacemaker implantation. However, the impact of pacemaker algorithms in AF prevention is not well understood. OBJECTIVE The purpose of this study was to evaluate the role of pacing algorithms in preventing AF progression. METHODS A systematic search of articles using the PubMed and Embase databases resulted in a total of 754 references. After exclusions, 21 randomized controlled trials (8336 patients) were analyzed, comprising studies reporting ventricular pacing percentage (VP%) (AAI vs DDD, n = 1; reducing ventricular pacing [RedVP] algorithms, n = 2); and atrial pacing therapies (atrial preference pacing [APP], n = 14; atrial antitachycardia pacing [aATP]+APP, n = 3; RedVP+APP+aATP, n = 1). RESULTS Low VP% (<10%) lead to a nonsignificant reduction in the progression of AF (hazard ratio [HR] 0.80; 95% confidence interval [CI] 0.57-1.13; P = .21; I2 = 67%) compared to high VP% (>10%). APP algorithm reduced premature atrial complexes (PAC) burden (mean difference [MD] -1117.74; 95% CI -1852.36 to -383.11; P = .003; I2 = 67%) but did not decrease AF burden (MD 8.20; 95% CI -5.39 to 21.80; P = .24; I2 = 17%) or AF episodes (MD 0.00; 95% CI -0.24 to 0.25; P = .98; I2 = 0%). Similarly, aATP+APP programming showed no significant difference in AF progression (odds ratio 0.65; 95% CI 0.36-1.14; P = .13; I2 = 61%). No serious adverse events related to algorithm were reported. CONCLUSION This meta-analysis of randomized controlled trials demonstrated that algorithms to reduce VP% can be considered safe. Low burden VP% did not significantly suppress AF progression. The atrial pacing therapy algorithms could suppress PAC burden but did not prevent AF progression.
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Affiliation(s)
- Dian A Munawar
- Centre for Heart Rhythm disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia; Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Rajiv Mahajan
- Centre for Heart Rhythm disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia; Department of Cardiology, Lyell McEwin Hospital, Adelaide, Australia
| | - Thomas A Agbaedeng
- Centre for Heart Rhythm disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Anand Thiyagarajah
- Centre for Heart Rhythm disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Darragh J Twomey
- Centre for Heart Rhythm disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Kashif Khokhar
- Centre for Heart Rhythm disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Catherine O'Shea
- Centre for Heart Rhythm disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Glenn D Young
- Centre for Heart Rhythm disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Kurt C Roberts-Thomson
- Centre for Heart Rhythm disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Muhammad Munawar
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Dennis H Lau
- Centre for Heart Rhythm disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
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Zungsontiporn N, Loguidice M, Daniels J. Important Parameters for Implantable Cardioverter Defibrillator Selection. Card Electrophysiol Clin 2019; 10:145-152. [PMID: 29428136 DOI: 10.1016/j.ccep.2017.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The efficacy of implantable cardioverter defibrillators in reducing the risk of sudden cardiac death has been well established by several clinical trials. Several factors relating to device characteristics, patient attributes, and comorbidities should be considered when selecting the appropriate implantable cardioverter defibrillators for each patient. This review examines some of these issues.
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Affiliation(s)
- Nath Zungsontiporn
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Michael Loguidice
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - James Daniels
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
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Abstract
PURPOSE OF REVIEW Pacemakers are frequently implanted in patients with atrial fibrillation. Many patients with pacemakers also develop atrial fibrillation. Over a period of time, through many studies on different pacing modes, sites, and algorithms, significant insights have been gained in the field of treatment and prevention of atrial fibrillation. The purpose of this review is to discuss some aspects of the scientific basis, current standards and possible future research related to cardiac pacing for prevention of atrial fibrillation. RECENT FINDINGS Trials involving pacing at the alternative pacing site per se or in combination with specific algorithms for prevention of atrial fibrillation have not shown consistent results. Recently, a new generation of antitachycardia pacing therapies has brought on a new optimism with promising outcome data of reduction in permanent atrial fibrillation, cardiovascular hospitalizations, and mortality. SUMMARY Multiple trials and clinical observational studies of different pacing methods and algorithms, with the exception of newer therapies in conjunction with atrial pacing algorithms, have not been shown to prevent atrial fibrillation. Hence, while permanent pacing is indicated for sinus node dysfunction and conduction abnormalities in patients with or without atrial fibrillation, the prevailing data in the literature does not support implantation of a permanent pacemaker for prevention of atrial fibrillation per se.
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Kantharia BK. Pacing for treatment and prevention of atrial fibrillation: Is there an end to this story? Heart Rhythm 2015; 12:1726-7. [DOI: 10.1016/j.hrthm.2015.04.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Indexed: 11/25/2022]
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Silva R, Pereira T, Martins V. Eficácia das terapias de pacing auricular antitaquicardia no tratamento da fibrilhação auricular paroxística em doentes portadores de pacemaker. Rev Port Cardiol 2014; 33:781-8. [DOI: 10.1016/j.repc.2014.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 05/19/2014] [Accepted: 06/06/2014] [Indexed: 11/17/2022] Open
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Silva R, Pereira T, Martins V. Effectiveness of atrial antitachycardia pacing in the treatment of paroxysmal atrial fibrillation in patients with pacemakers. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2014.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Hohnloser SH, Healey JS, Gold MR, Israel CW, Yang S, van Gelder I, Capucci A, Lau CP, Fain E, Morillo CA, Ha A, Carlson M, Connolly SJ. Atrial overdrive pacing to prevent atrial fibrillation: Insights from ASSERT. Heart Rhythm 2012; 9:1667-73. [DOI: 10.1016/j.hrthm.2012.06.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Indexed: 12/22/2022]
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van Hemel NM. Higher rates to reduce irregularity: the use of overdrive pacing in atrial fibrillation. Europace 2011; 13:1667-8. [DOI: 10.1093/europace/eur276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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ELKAYAM LIORU, KOEHLER JODIL, SHELDON TODDJ, GLOTZER TAYAV, ROSENTHAL LAWRENCES, LAMAS GERVASIOA. The Influence of Atrial and Ventricular Pacing on the Incidence of Atrial Fibrillation: A Meta-Analysis. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:1593-9. [DOI: 10.1111/j.1540-8159.2011.03192.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kohno R, Abe H, Oginosawa Y, Tamura M, Takeuchi M, Nagatomo T, Otsuji Y. Reliability and Characteristics of Atrial Tachyarrhythmias Detection in Dual Chamber Pacemakers. Circ J 2011; 75:1090-7. [DOI: 10.1253/circj.cj-10-0896] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ritsuko Kohno
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Yasushi Oginosawa
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Masahito Tamura
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Masaaki Takeuchi
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Toshihisa Nagatomo
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Yutaka Otsuji
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
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Janko S, Hoffmann E. Atrial antitachycardia pacing: do we still need to talk about it? Europace 2009; 11:977-9. [DOI: 10.1093/europace/eup182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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