Nakatsuji Kota, Otsuki Sou, Kamakura Tsukasa, Oshima Tsukasa, Nakamura Toshihiro, Oka Satoshi, Miyazaki Yuichiro, Wakamiya Akinori, Ueda Nobuhiko, Nakajima Kenzaburo, Wada Mitsuru, Ishibashi Kohei, Inoue Yuko, Miyamoto Koji, Aiba Takeshi, Kusano Kengo
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
Heart Rhythm O2. 2025 May 11;6(7):960-968. doi: 10.1016/j.hroo.2025.05.001. eCollection 2025 Jul.
A second-generation atrial antitachycardia pacing (ATP), reactive ATP (rATP), was effective in preventing progression to permanent atrial fibrillation (AF) in patients with sick sinus syndrome (SSS) over a 2-year follow-up period. However, its long-term results and efficacy in patients with atrioventricular block (AVB) remain uncertain.
This study aimed to evaluate the long-term efficacy of rATP in patients implanted with pacemakers owing to SSS and AVB.
The incidence of progression to permanent AF was compared between 2 groups of the 349 patients implanted with dual-chamber pacemakers (134 with rATP function [rATP group] and 215 without rATP [control group]).
During the follow-up period (1906 ± 950 days), 57.5% of the patients in the rATP group and 55.3% in the control group experienced atrial tachyarrhythmia episodes lasting > 1 minute ( = .74). The incidence of progression to permanent AF was significantly lower in patients with SSS and AVB in the rATP group than in the control group (log-rank, SSS, = .036; AVB, = .029). Multivariable analysis showed that the use of rATP was a significant factor associated with a lower incidence of permanent AF progression. No severe complications related to rATP delivery were observed. Deliveries of ≥ 300 ATP sequences per month were associated with rapid battery drainage.
Progression to permanent AF was reduced by rATP in patients with SSS and AVB. Treatment efficacy and safety were sustained over 5 years. Clinical benefits and the risk of battery drainage should be balanced.
第二代心房抗心动过速起搏（ATP），即反应性ATP（rATP），在2年的随访期内可有效预防病态窦房结综合征（SSS）患者进展为永久性心房颤动（AF）。然而，其在房室传导阻滞（AVB）患者中的长期结果和疗效仍不确定。
本研究旨在评估rATP在因SSS和AVB植入起搏器患者中的长期疗效。
比较植入双腔起搏器的349例患者中两组（134例具有rATP功能[rATP组]和215例无rATP[对照组]）进展为永久性AF的发生率。
在随访期（1906±950天）内，rATP组57.5%的患者和对照组55.3%的患者经历了持续>1分钟的房性快速心律失常发作（P=0.74）。rATP组中SSS和AVB患者进展为永久性AF的发生率显著低于对照组（对数秩检验，SSS，P=0.036；AVB，P=0.029）。多变量分析显示，使用rATP是与永久性AF进展发生率较低相关的显著因素。未观察到与rATP递送相关的严重并发症。每月≥300次ATP序列的递送与电池快速耗尽相关。
rATP可降低SSS和AVB患者进展为永久性AF的发生率。治疗效果和安全性在5年内得以维持。应平衡临床益处和电池耗尽风险。
