Adaptive bi-atrial pacing improves the maintenance of sinus rhythm

Introduction: Multiple pacing modalities have been shown to individually decrease atrial fibrillation (AF) burden and relieve symptoms of AF. This investigation retrospectively evaluated whether a combination of bi-atrial pacing with dynamic atrial overdrive (DAO) AF suppression would further decrease AF burden as compared to AF suppression (DAO) alone. Methods and Results: A total of 33 patients were retrospectively evaluated. Patients (n = 16) were identified from the Deborah Heart and Lung Center pacemaker database with DAO programmed on at time of implantation. Patients (n = 17) were identified with bi-atrial pacing leads in right atrium and mid to distal coronary sinus who also had DAO programmed on at the time of implant. Evaluation of interrogated pacing data revealed Percent Time in Mode Switch (18.2% +/- 7.2% vs 0.59% +/- 0.08%) to be significantly lower (P = 0.014) in the bi-atrial paced group. In addition, there were less mode switches per day (MSPD) in the bi-atrial paced group (0.62 +/- 0.43 MSPD) versus control (4.40 +/- 3.24 MSPD) (P = 0.06). Conclusion: Bi-atrial pacing while used in conjunction with an adaptive pacing suppression algorithm (DAO) may successfully be used to inhibit PAF.