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The usefulness of minimal ventricular pacing and preventive AF algorithms in the treatment of PAF: the 'MinVPace'
Rick A Veasey1, Anita Arya, Nick Freemantle
1Department of Cardiology, East Sussex Hospitals NHS Trust, Eastbourne, UK.
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 + or - 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.
Insights
Minimizing ventricular pacing (MinVP) effectively reduces ventricular pacing but does not significantly lower atrial fibrillation burden in the short term. Adding anti-AF algorithms offers no additional benefit.
Area of Science:
- Cardiology
- Biomedical Engineering
- Electrophysiology
Background:
- Atrial pacing benefits for paroxysmal atrial fibrillation (PAF) can be offset by excessive ventricular pacing.
- This study investigates pacing algorithms designed to minimize ventricular pacing (MinVP) and their impact on AF burden (AFB).
Purpose of the Study:
- To evaluate the efficacy of MinVP algorithms, with and without anti-AF functionalities, in reducing AFB in patients with symptomatic PAF.
- To compare the effects of MinVP algorithms against standard dual-chamber rate-adaptive pacing (DDDR).
Main Methods:
- A prospective, randomized study involving 110 patients with pacemakers capable of MinVP.
- Patients were randomized to three 2-month phases: DDDR pacing, MinVP pacing, and MinVP with anti-AF algorithms.
- Atrial fibrillation burden (AFB) was the primary outcome measure.
Main Results:
- Sixty-six patients completed the study; no significant difference in AFB was observed between DDDR (13.8%), MinVP (14.4%), and MinVP with anti-AF algorithms (14.7%).
- Median ventricular pacing was significantly reduced with MinVP (2.0%) and MinVP + algorithms (3.0%) compared to DDDR (86.0%).
- No additional benefit or adverse outcomes were noted with the addition of anti-AF algorithms to MinVP.
Conclusions:
- MinVP algorithms are highly effective in reducing ventricular pacing.
- Short-term use of MinVP algorithms does not significantly decrease atrial fibrillation burden in patients with symptomatic PAF.
- Preventive anti-AF algorithms combined with MinVP do not provide additional benefits for AF burden reduction.
