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
Abstract Background Reactive 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...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-10-01
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| Series: | International Journal of Arrhythmia |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s42444-023-00104-3 |
| _version_ | 1797578068964933632 |
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| author | Cody Carter Zeryab Khan Rayan El-Zein Marie Lockhart Ankur Shah David Nemer Jaret Tyler Eugene Fu Auroa Badin Sreedhar R. Billakanty Anish K. Amin Nagesh Chopra |
| author_facet | Cody Carter Zeryab Khan Rayan El-Zein Marie Lockhart Ankur Shah David Nemer Jaret Tyler Eugene Fu Auroa Badin Sreedhar R. Billakanty Anish K. Amin Nagesh Chopra |
| author_sort | Cody Carter |
| collection | DOAJ |
| description | Abstract Background Reactive 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. Methods Data 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. Results The 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). Conclusion rATP 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. |
| first_indexed | 2024-03-10T22:18:00Z |
| format | Article |
| id | doaj.art-0785af2abb414d0ab9c39f74632d9629 |
| institution | Directory Open Access Journal |
| issn | 2466-1171 |
| language | English |
| last_indexed | 2024-03-10T22:18:00Z |
| publishDate | 2023-10-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal of Arrhythmia |
| spelling | doaj.art-0785af2abb414d0ab9c39f74632d96292023-11-19T12:22:59ZengBMCInternational Journal of Arrhythmia2466-11712023-10-012411710.1186/s42444-023-00104-3Reactive 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 deviceCody Carter0Zeryab Khan1Rayan El-Zein2Marie Lockhart3Ankur Shah4David Nemer5Jaret Tyler6Eugene Fu7Auroa Badin8Sreedhar R. Billakanty9Anish K. Amin10Nagesh Chopra11Department of Internal Medicine, OhioHealth Doctors HospitalDepartment of Internal Medicine, OhioHealth Doctors HospitalDepartment of Internal Medicine, OhioHealth Doctors HospitalOhioHealth Research InstituteSection of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist HospitalSection of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist HospitalSection of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist HospitalSection of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist HospitalSection of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist HospitalSection of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist HospitalSection of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist HospitalSection of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist HospitalAbstract Background Reactive 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. Methods Data 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. Results The 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). Conclusion rATP 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.https://doi.org/10.1186/s42444-023-00104-3AtrialAnti-tachycardia pacingLeft atrial appendage closureAtrial fibrillationCardiovascular implantable electronic deviceThromboembolism |
| spellingShingle | Cody Carter Zeryab Khan Rayan El-Zein Marie Lockhart Ankur Shah David Nemer Jaret Tyler Eugene Fu Auroa Badin Sreedhar R. Billakanty Anish K. Amin Nagesh Chopra 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 Atrial Anti-tachycardia pacing Left atrial appendage closure Atrial fibrillation Cardiovascular implantable electronic device Thromboembolism |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | Atrial Anti-tachycardia pacing Left atrial appendage closure Atrial fibrillation Cardiovascular implantable electronic device Thromboembolism |
| url | https://doi.org/10.1186/s42444-023-00104-3 |
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