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@article{1335104,
author = {Ricci, R.P. and Botto, G.L. and Benezet, J.M. and Nielsen, J.C. and De Roy, L. and Piot, O. and Quesada, A. and Quaglione, R. and Vaccari, D. and Mangoni, L. and Grammatico, A. and Kozák, Milan},
article_location = {USA},
article_number = {11},
doi = {http://dx.doi.org/10.1016/j.hrthm.2015.06.041},
keywords = {Cardiac pacing; Managed ventricular pacing; Randomized controlled trial; Atrial fibrillation; PR interval},
language = {eng},
issn = {1547-5271},
journal = {Heart Rhythm},
title = {Association between ventricular pacing and persistent atrial fibrillation in patients indicated to elective pacemaker replacement: Results of the Prefer for Elective Replacement MVP (PreFER MVP) randomized study},
volume = {12},
year = {2015}
}
TY - JOUR
ID - 1335104
AU - Ricci, R.P. - Botto, G.L. - Benezet, J.M. - Nielsen, J.C. - De Roy, L. - Piot, O. - Quesada, A. - Quaglione, R. - Vaccari, D. - Mangoni, L. - Grammatico, A. - Kozák, Milan
PY - 2015
TI - Association between ventricular pacing and persistent atrial fibrillation in patients indicated to elective pacemaker replacement: Results of the Prefer for Elective Replacement MVP (PreFER MVP) randomized study
JF - Heart Rhythm
VL - 12
IS - 11
SP - 2239-2246
EP - 2239-2246
PB - Elsevier Science
SN - 15475271
KW - Cardiac pacing
KW - Managed ventricular pacing
KW - Randomized controlled trial
KW - Atrial fibrillation
KW - PR interval
N2 - BACKGROUND Pacing in the right ventricle can cause a variety of detrimental effects, including atrial tachyarrhythmias (atrial tachycardia [AT]/atrial fibrillation [AF]). OBJECTIVE The purpose of this study was to evaluate the incidence and predictors of persistent AT/AF in patients with long-term exposure to ventricular pacing. METHODS In a multicenter international trial, 605 patients (age 75 +/- 11 years, 240 women) referred for replacement of an implanted pacemaker or implantable cardioverter-defibrillator (ICD), with a history of high-percentage (>40%) ventricular pacing, were randomly allocated to standard dual-chamber pacing or managed ventricular pacing (MVP), a pacing modality that minimizes ventricular pacing. The main end-point of this secondary analysis of the PreFER MVP randomized study was persistent AT/AF, defined as >= 7 consecutive days with AT/AF or AT/AF interrupted by atrial cardioversion or AT/AF present during 2 consecutive follow-up visits. RESULTS Persistent AT/AF was observed in 71 patients (11.7%) after 2 years of follow-up. At multivariable Cox regression analysis, prior AT/AF (hazard ratio [HR] 2.85, 95% confidence interval [CI] 1.20-6.22, P = .017) and ventricular pacing percentage, estimated in the first 3 months, >= 10% (HR 3.24, 95%95% CI 1.13-9.31, P = .029) were independent predictors for persistent AT/AF. MVP was associated with persistent AT/AF risk (HR 3.41, 95% 95% CI 1.10-10.6, P = .024) in the subgroup of patients with baseline long PR interval (PR >230 ms) but not in the whole population. CONCLUSION In pacemaker and ICD replacement patients, a high percentage of ventricular pacing is associated with higher risk of persistent AT/AF. Use of algorithms that minimize right ventricular pacing may benefit patients with normal spontaneous AV conduction but should be evaluated with caution in patients with long PR interval.
ER -
RICCI, R.P., G.L. BOTTO, J.M. BENEZET, J.C. NIELSEN, L. DE ROY, O. PIOT, A. QUESADA, R. QUAGLIONE, D. VACCARI, L. MANGONI, A. GRAMMATICO and Milan KOZÁK. Association between ventricular pacing and persistent atrial fibrillation in patients indicated to elective pacemaker replacement: Results of the Prefer for Elective Replacement MVP (PreFER MVP) randomized study. \textit{Heart Rhythm}. USA: Elsevier Science, 2015, vol.~12, No~11, p.~2239-2246. ISSN~1547-5271. Available from: https://dx.doi.org/10.1016/j.hrthm.2015.06.041.
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