Pürerfellner Helmut, Urban Lubos, de Weerd Gerjan, Ruiter Jaap, Brandt Johan, Havlicek Ales, Hügl Burkhard, Widdershoven Jos, Kornet Lilian, Kessels Roger
1Internal Department/Division of Cardiology, Public Hospital Elisabethinen, Academic Teaching Hospital, Fadingerstrasse 1, A-4010 Linz, Austria.
Europace. 2009 Jan;11(1):62-9. doi: 10.1093/europace/eun294. Epub 2008 Nov 12.
Two independent studies have revealed a potential limitation of post-mode switch overdrive pacing (PMOP), which is its delayed start.
We conducted a prospective, randomized, single blind, crossover design study (the post-long pause overdrive pacing study) to test the efficacy of an improved version of PMOP (PMOP(enhanced)). A total of 45 patients were enrolled, of whom 41 were analysed. The median number of atrial tachycardia/atrial fibrillation (AT/AF) episodes per day (1.38 vs. 1.19), the median number of early recurrences of atrial fibrillation (ERAF) per day (0.56 vs. 0.51), and the median AT/AF burden (time per day spent in AT/AF) (2.47 vs. 2.51 h) were not significantly different during the control and active study periods. Based on the median number of episodes per week recorded 90 days prior to enrollment, the patients were stratified by the median and then split into two groups, Group A (lower 2-Quartiles) and Group B (upper 2-Quartiles). The median AT/AF burden was significantly lower in Group B during the active study period (3.71 vs. 1.71 h, P = 0.02).The median number of AT/AF episodes per day and the median number of ERAF per day in Group B showed a trend towards reduction when the algorithm was turned on (3.79 vs. 2.44 and 2.77 vs. 1.86, respectively). In contrast, in Group A we did not demonstrate any difference in AT/AF frequency, ERAF frequency, or burden.
The main finding of this study is that temporary overdrive pacing at 90 bpm for 10 min starting just prior to device-classified AT/AF termination does not show a positive effect on the overall study population. However, when enabled in patients who suffer from a high percentage of ERAF, a significant reduction in the AT/AF burden could be demonstrated. Based on these findings, further prospective studies on a more targeted patient population are needed to confirm our results.
两项独立研究揭示了模式转换后超速起搏（PMOP）存在一个潜在局限性，即其启动延迟。
我们进行了一项前瞻性、随机、单盲、交叉设计研究（长间歇后超速起搏研究），以测试改良版PMOP（PMOP(增强版)）的疗效。共纳入45例患者，其中41例进行了分析。在对照期和活跃研究期，每日房性心动过速/心房颤动（AT/AF）发作的中位数（1.38对1.19）、每日心房颤动早期复发（ERAF）的中位数（0.56对0.51）以及AT/AF负荷（每日处于AT/AF状态的时间）中位数（2.47对2.51小时）无显著差异。根据入组前90天记录的每周发作中位数，患者按中位数分层，然后分为两组，A组（下四分位数）和B组（上四分位数）。在活跃研究期，B组的AT/AF负荷中位数显著更低（3.71对1.71小时，P = 0.02）。当算法开启时，B组每日AT/AF发作的中位数和每日ERAF的中位数呈下降趋势（分别为3.79对2.44以及2.77对1.86）。相比之下，在A组中，我们未发现AT/AF频率、ERAF频率或负荷有任何差异。
本研究的主要发现是，在设备判定的AT/AF终止前即刻开始以90次/分钟进行10分钟的临时超速起搏，对总体研究人群未显示出积极效果。然而，在ERAF发生率较高的患者中启用时，可证明AT/AF负荷显著降低。基于这些发现，需要对更具针对性的患者群体进行进一步的前瞻性研究以证实我们的结果。
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