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Is competitive atrial pacing a possible trigger for atrial fibrillation? Observations from the RATE registry

Michael V Orlov1, Brian Olshansky2, David G Benditt3

  • 1Department of Medicine, Steward St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Massachusetts.

Heart Rhythm
|August 2, 2020
PubMed

Insights

Device-triggered atrial tachycardia and atrial fibrillation (AT/AF) from competitive atrial pacing (CAP) is common in patients with cardiac implantable electronic devices (CIEDs). This device-triggered AT/AF differs from spontaneous AT/AF in duration and morphology.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Device Technology

Background:

  • Asymptomatic atrial tachycardia and atrial fibrillation (AT/AF) are frequently detected in patients with cardiac implantable electronic devices (CIEDs).
  • The clinical significance of device-detected AT/AF, particularly episodes triggered by competitive atrial pacing (CAP), remains uncertain.

Purpose of the Study:

  • To investigate and characterize the association between CAP and AT/AF.
  • To analyze the largest series of observations to date regarding CAP-triggered AT/AF.

Main Methods:

  • Analysis of electrograms (EGMs) from 1352 patients within the RATE multicenter registry (5379 patients total) with CIEDs.
  • Experienced adjudicators assessed the causal relationship between AT/AF and CAP onset, duration, and morphology in 1352 patients.

Main Results:

  • A strong association was found between CAP and AT/AF (P ≤ .02) in 225 patients with 1394 episodes.
  • In 62% of episodes, CAP was concluded to trigger AT/AF.
  • CAP-triggered AT/AF episodes exhibited variable EGM morphology and shorter cycle lengths compared to spontaneous AT/AF.

Conclusions:

  • Device-triggered AT/AF due to CAP is more prevalent than previously thought.
  • Device-triggered AT/AF is distinct from spontaneous AT/AF in terms of duration and morphology.
  • The clinical implications of device-triggered AT/AF may differ from those of spontaneous AT/AF.
Abstract

Keywords:
Atrial tachyarrhythmiasCardiac implantable devicesCompetitive atrial pacingElectrogramRepetitive nonreentrantSubclinical atrial fibrillationTriggered atrial fibrillationVentriculoatrial synchrony

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