Efficacy of pacing therapies for treating atrial tachyarrhythmias in patients with ventricular arrhythmias receiving a dual-chamber implantable cardioverter defibrillator

Background-Although overdrive pacing for treating atrial flutter is well established, the efficacy of device-based atrial pacing for treating spontaneous atrial tachyarrhythmias in patients with implantable cardioverter defibrillators (ICD) is unknown. This study evaluated the efficacy of novel pacing therapies for treating atrial tachyarrhythinias in patients receiving a dual-chamber ICD to treat ventricular tachyarrhythmias. Methods and Results-A Jewel AF ICD was implanted in 537 patients with ventricular arrhythmia who were followed for 11.4 +/- 8.2 months (74% had a documented history of atrial tachyarrhythmias). The device discriminated atrial tachycardia (AT) from atrial fibrillation (AF) on the basis of cycle length and regularity, and it used 3 different methods of overdrive atrial pacing (Ramp, Burst+, and 50-Hz burst) to treat AT episodes and one method (50-Hz burst) to treat AF episodes. Pacing successfully terminated 59% of 1500 spontaneous AT episodes in 127 patients and 30% of 880 AY episodes in 101 patients (P < 0.001). With AT and AF episodes combined, pacing efficacy was 48%. Pacing efficacy was significantly reduced at AT cycle lengths less than or equal to 220 ins and AF cycle lengths less than or equal to 160 ms (P < 0.01) The median time from pacing to AT/AF termination was 1.1 minute for the pacing successes and 96 minutes for the failures (P < 0.001). Conclusions-Atrial pacing terminated 48% of AT/AF episodes in patients with a history of ventricular arrhythmias. Pacing efficacy was greater for device-classified AT than AF. Pacing efficacy was significantly influenced by tachycardia cycle length. Successful pacing significantly reduces the time required for AT/AF termination.