Padeletti Luigi, Muto Carmine, Maounis Themistoclis, Schuchert Andreas, Bongiorni Maria-Grazia, Frank Robert, Vesterlund Thomas, Brachmann Johannes, Vicentini Alfredo, Jauvert Gaël, Tadeo Giorgio, Gras Daniel, Lisi Francesco, Dello Russo Antonio, Rey Jean-Luc, Boulogne Eric, Ricciardi Giuseppe
Ospedale Careggi, Florence, Italy.
Am Heart J. 2008 Sep;156(3):520-6. doi: 10.1016/j.ahj.2008.04.013. Epub 2008 Jul 7.
Atrial fibrillation (AF) is associated with increased morbidity and mortality in patients suffering from heart failure (HF). Patients in New York Heart Association HF classes III or IV, with systolic dysfunction and a wide QRS, are candidates for cardiac resynchronization therapy (CRT), and might benefit from atrial overdrive pacing (AOP).
The Management of Atrial fibrillation Suppression in AF-HF COmorbidity Therapy (MASCOT) trial enrolled 409 CRT device recipients (79% men), who were randomly assigned to AOP ON (n = 197), versus AOP OFF (n = 197) and followed up for 1 year. Their mean age was 68 +/- 10 years, left ventricular ejection fraction 25 +/- 6%, QRS duration 163 +/- 29 milliseconds. New York Heart Association class III was present in 86% of patients and 19% had a history of paroxysmal AF. The primary study end point was incidence of permanent AF at 1 year.
Atrial overdrive pacing increased the percentage of atrial pacing from 30% to 80% (P < .0001), was well tolerated, and did not interfere with (a) delivery of CRT (95% mean ventricular pacing in both groups), (b) response to CRT (70% responders in the control vs 67% in the treatment group), or (c) cardiac function (left ventricular ejection fraction increased from 24.5% +/- 6.2% to 32.7% +/- 10.9% in the control and from 25.8% +/- 6.8% to 33.1% +/- 12.6% in the treatment group). The incidence of permanent AF was 3.3% in both groups. By logistic regression analysis, a history of AF (P < .001) and absence of antiarrhythmic drugs (P = .002) were associated with permanent AF.
In this first trial of a specific AF prevention algorithm in CRT recipients, AOP was safe and did not worsen HF. The prevention algorithm did not lower the 1-year incidence of AF.
心房颤动（AF）与心力衰竭（HF）患者的发病率和死亡率增加相关。纽约心脏协会HF III或IV级、伴有收缩功能障碍和宽QRS波的患者是心脏再同步治疗（CRT）的候选者，可能从心房超速起搏（AOP）中获益。
心房颤动合并心力衰竭共病治疗中心房颤动抑制管理（MASCOT）试验纳入了409名CRT装置接受者（79%为男性），他们被随机分配至AOP开启组（n = 197）和AOP关闭组（n = 197），并随访1年。他们的平均年龄为68±10岁，左心室射血分数为25±6%，QRS波时限为163±29毫秒。86%的患者为纽约心脏协会III级，19%有阵发性AF病史。主要研究终点是1年时永久性AF的发生率。
心房超速起搏使心房起搏百分比从30%增加到80%（P <.0001），耐受性良好，且不干扰（a）CRT的发放（两组平均心室起搏率均为95%），（b）对CRT的反应（对照组70%有反应，治疗组67%有反应），或（c）心功能（对照组左心室射血分数从24.5%±6.2%增加到32.7%±10.9%，治疗组从25.8%±6.8%增加到33.1%±12.6%）。两组永久性AF的发生率均为3.3%。通过逻辑回归分析，AF病史（P <.001）和未使用抗心律失常药物（P =.002）与永久性AF相关。
在这项针对CRT接受者的特定AF预防方案的首次试验中，AOP是安全的，且未使HF恶化。该预防方案未降低AF的1年发生率。
