Impact of anti-tachycardia pacing on atrial fibrillation burden when added on top of preventive pacing algorithms: results of the prevention or termination (POT) trial

Abstract

Aims: The efficacy of preventive pacing algorithms (PPA) and anti-tachycardia pacing (ATP) in reducing atrial fibrillation (AF) burden remains controversial. The aim of this study was to assess whether ATP on top of PPA decreases AF burden.

Methods and results: A series of 199 consecutive patients, with conventional indications for pacing, and documented AF, received a DDDR (rate adaptive dual chamber pacemaker) pacemaker with ATP capabilities (AT 500 Medtronic). After 3 months of conventional DDDR pacing at 70 b.p.m., AF burden was analysed. If patients had >30 min/week of AF, they were randomized to PPA or to PPA+ATP for 3 months (period 1). They were then crossed to the alternative therapy (period 2) and followed three additional months with a 1-month wash out period in-between. A group of 85 patients were randomized. Mean age 68 +/- 8 years, 61% men. Both groups showed a significant decrease in AF burden at the end of period 1 (64 and 81%, respectively).

Conclusions: Atrial pacing with PPA decreases AF burden in patients with pacing indication. We did not observe a further decrease in AF burden or in the number of episodes when adding ATP on top of PPA.