Impact of consistent atrial pacing algorithm on premature atrial complexe number and paroxysmal atrial fibrillation recurrences in brady-tachy syndrome: A randomized prospective cross over study

Aim of the study: The Consistent Atrial Pacing (CAP) algorithm has been designed to achieve a high percentage of atrial pacing to suppress paroxysmal atrial fibrillation. The aim of our study was to compare the impact of DDDR+CAP versus DDDR pacing on paroxysmal atrial fibrillation recurrences and triggers in patients with Brady-Tachy Syndrome. Methods: 61 patients, 23 M and 38 F, mean age 75 +/-9 y, affected by Brady-Tachy Syndrome, implanted with a DDDR pacemaker, were randomized to DDDR or DDDR+CAP pacing with cross over of pacing modality after 1 month. Results: 78% of patients in DDDR pacing and 73% in DDDR+CAP pacing (p=n.s.) were free from symptomatic paroxysmal atrial fibrillation recurrences. During DDDR+CAP pacing, the atrial pacing percentage increased from 77 +/- 29% to 96 +/-7% (p <0.0001). Automatic mode switch episodes/day were 0.73 +/-1.09 in DDDR and 0.79 +/-1.14 (p=n.s.) in DDDR+CAP. In patients with less than 50% of atrial pacing during DDDR, automaticmode switch episodes/day decreased during DDDR+CAP from 1.13 +/-1.59 to 0.23 +/-0.32 (p <0.05) and in patients with less than 90% from 1.23 +/-1.27 to 0.75 +/-1.10 (p <0.001). The number of premature atrial complexes per day decreased during DDDR+CAP from 2665 +/- 4468 to 556 +/- 704 (p <0.02). Conclusion: CAP algorithm allowed continuous overdrive atrial pacing without major side effects. Triggers of paroxysmal atrial fibrillation induction, such as premature atrial complexes, were critically decreased. Paroxysmal atrial fibrillation episodes were reduced in patients with atrial pacing percentage lower than 90 % during DDDR pacing.