The usefulness of minimal ventricular pacing and preventive AF algorithms in the treatment of PAF: the ‘MinVPace’ study

• Published in: Journal of interventional cardiac electrophysiology Vol. 28; no. 1; pp. 51 - 57
• Main Authors: Veasey, Rick A., Arya, Anita, Freemantle, Nick, Silberbauer, John, Patel, Nikhil R., Lloyd, Guy W., Sulke, A. Neil
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.06.2010; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Algorithms; Atrial Fibrillation - prevention & control; Atrial Fibrillation - therapy; Cardiac Pacing, Artificial - methods; Cardiology; Confidence Intervals; Electrocardiography; Female; Follow-Up Studies; Humans; Male; Medicine; Medicine & Public Health; Pacemaker, Artificial; Prospective Studies; Risk Assessment; Severity of Illness Index; Tachycardia, Paroxysmal - diagnosis; Tachycardia, Paroxysmal - therapy; Treatment Outcome; Right ventricular pacing; Minimal ventricular pacing; AF algorithms; Atrial fibrillation
• ISSN: 1383-875X; 1572-8595
• DOI: 10.1007/s10840-009-9461-0

Introduction The beneficial effects of atrial pacing on the incidence, duration and symptomatology of paroxysmal atrial fibrillation (PAF) may be negated by increased ventricular pacing. This prospective randomised study evaluates the effect of pacing algorithms that minimise ventricular pacing (MinVP) with and without anti-AF algorithms, on AF burden (AFB) in patients with symptomatic PAF. Methods Patients implanted with pacemakers with MinVP capability with AFB 1–70% were enrolled. Three different DDDRP devices were assessed. Following a 1-month induction phase, patients were randomised to MinVP with and without preventive AF algorithms or dual chamber rate adaptive pacemaker (DDDR) (AV delay (AVD) 150 ms) for 2 months per study phase. The primary outcome measure was AFB. Results One hundred and ten patients were enrolled; of these, 66 (mean age 74.3 ± 7.9, 56% males) had an AFB of 1–70% during the induction phase and completed all study phases. There was no significant difference in AFB between the control phase DDDR, 13.8% (95% CI 8.7 to 18.8), and MinVP, 14.4% (95% CI 9.4 to 19.4), or MinVP with AF algorithms enabled, 14.7% (95% CI 9.7 to 19.7), ( p  = 0.65 and p  = 0.49, respectively). Median ventricular pacing was significantly higher during the control phase, 86.0% (IQR 72.8, 97.3), than in MinVP 2.0% (IQR 0.0, 14.1) and MinVP + algorithms 3.0% (IQR 0.4, 15.6), p  = < 0.001. Conclusion MinVP algorithms are effective in reducing ventricular pacing. However, there is no significant reduction in AFB with minimal ventricular pacing algorithms in the short term. No additional benefit or adverse outcome was found with preventative anti-AF algorithms in combination with MinVP algorithms.