Reactive atrial-based anti-tachycardia pacing algorithm in cardiovascular implantable electronic devices is safe and feasible without increase in thromboembolic events in patients with a left atrial appendage closure device

International Journal of Arrhythmia

Research

Zeryab Khan¹  Rayan El-Zein¹  Cody Carter²  Marie Lockhart³  Anish K. Amin⁴  Sreedhar R. Billakanty⁴  Auroa Badin⁴  Eugene Fu⁴  David Nemer⁴  Jaret Tyler⁴  Ankur Shah⁴  Nagesh Chopra⁴ 

[1] Department of Internal Medicine, OhioHealth Doctors Hospital, 5100 West Broad Street, 43228, Columbus, OH, USA;Department of Internal Medicine, OhioHealth Doctors Hospital, 5100 West Broad Street, 43228, Columbus, OH, USA;Department of Cardiology, Doctors Hospital, 5100 W Broad St., 43228, Columbus, OH, USA;OhioHealth Research Institute, 3545 Olentangy River Road, Suite 301, 43214, Columbus, OH, USA;Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Road, 43214, Columbus, OH, USA;

关键词: Atrial;    Anti-tachycardia pacing;    Left atrial appendage closure;    Atrial fibrillation;    Cardiovascular implantable electronic device;    Thromboembolism;   

DOI  :  10.1186/s42444-023-00104-3

 received in 2023-06-09, accepted in 2023-09-09,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundReactive atrial-based anti-tachycardia pacing (rATP) in CIED (cardiovascular implantable electronic devices) is effective in atrial fibrillation (AF) suppression. Uninterrupted systemic anticoagulation is recommended when this algorithm is activated to avoid stroke, however, the use of a rATP algorithm in patients with a left atrial appendage (LAA) closure device has not been studied. We assessed the safety and feasibility of rATP algorithm to suppress AF in patients with a LAA closure device over an extended period.MethodsData from 55 consecutive patients who underwent a Watchman® implant at a tertiary care hospital between September 1, 2015, and January 30, 2020, who also had an in situ Medtronic® CIED (45 with and 10 without rATP capability) were retrospectively reviewed.ResultsThe 55-patient cohort was 60% male, 77 ± 8 years old, CHA2DS2-VASc score 5 (4–6), HAS-BLED score 3 (3–4), LVEF 53 ± 14%, LA size 4.4 ± 0.7 cm and ventricular pacing burden of 73 (1.4–98.3)%. The CIEDs (20 ICDs and 35 pacemakers) antedated Watchman® implants by 915 ± 725 days. Post-implant, all patients discontinued anticoagulation. Twenty patients in the rhythm-control group with active rATP algorithm displayed no increase in yearly AF burden and were less likely to develop permanent/long-standing persistent AF (p = 0.002) when compared to 35 patients in the rate-control group with CIEDs inactive/incapable of rATP over a ≤ 5-year follow-up. The longest AF episode in the rhythm-control group lasted 204 (19–2520) h. There was no increase in stroke/thromboembolism and a significant reduction in major bleeding noted over ≤ 5 years pre- versus post-implant in the whole cohort (p = 0.005).ConclusionrATP algorithm use is safe and feasible in patients with a Watchman® device. Patients should be forewarned of a surge in post-Watchman® implant AF burden.

【 授权许可】

CC BY   
© Korean Heart Rhythm Society 2023

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