The Atrial Pacing Peri-ablation for Paroxysmal Atrial Fibrillation (PA3) Study: rationale and study design

The Canadian Atrial Pacing Peri-Ablation for Paroxysmal Atrial Fibrillation Study tested the hypotheses that atrial pacing prevents paroxysmal atrial fibrillation (PAF) in patients without symptomatic bradycardia and that DDDR pacing is more likely to prevent PAF following total atrioventricular (AV) node ablation compared to VDD pacing. Patients with PAF who were refractory to or intolerant of antiarrhythmic drug therapy received a Medtronic Thera DR pacemaker 3 months prior to a planned total AV node ablation. Patients were randomized to atrial pacing or no pacing therapy. The time to first recurrence of sustained PAF was the primary study outcome event. Following AV node ablation, patients were randomized to the DDDR or VDD mode in a crossover study design. Patients were followed in each mode for 6 months. The time course of PAF recurrence was compared for each pacing mode.