Yang A, Ruiter J, Pfeiffer D, Esmailzadeh B, Welz A, Hochhäusler M, Nickenig G, Lüderitz B, Lewalter T. Identification of “substrate fibrillators” and “trigger fibrillators” by pacemaker diagnostics.
Heart Rhythm 2006;
3:682-8. [PMID:
16731470 DOI:
10.1016/j.hrthm.2006.01.030]
[Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Accepted: 01/25/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND
The population of patients likely to respond to selected pacing algorithms for maintenance of sinus rhythm is unknown.
OBJECTIVES
The purpose of this study was to identify patients with specific onset patterns of paroxysmal atrial fibrillation (AF).
METHODS
Dual-chamber pacemakers with advanced diagnostic functions were implanted in 112 patients with conventional indications for antibradycardia pacing and a history of paroxysmal AF. Pacemaker diagnostic data were analyzed after 97.5 +/- 40.9 days. According to the frequency of premature atrial contractions (PACs) during the 5 minutes before AF onset, patients were assigned to one of three groups: group A (high PAC activity), group B (moderate PAC activity), or group C (low PAC activity).
RESULTS
AF burden was lower in group A (4.6% +/- 2.4%) than group B (15.8% +/- 3.0%, P = .003) and group C (15.5% +/- 3.1%, P = .003). Fewer AF episodes occurred in group A (2.1 +/- 1.3 per day) than group B (3.8 +/- 1.2 per day, P = .006). Mean AF episode duration was shorter in group A (11.4 +/- 10.2 hours) than group C (41.4 +/- 27.5 hours, P = .03).
CONCLUSION
The coincidence of low PAC activity before AF onset, high AF burden, and extended arrhythmia episode duration appears to be the consequence of a high atrial substrate factor. In these "substrate fibrillators," the efficacy of pacing algorithms for maintenance of sinus rhythm may be limited. In contrast, "trigger fibrillators" exhibiting low AF burden despite high PAC incidence may represent the target population for specific PAC-suppressing pacing algorithms.
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