Heart Rhythm Society
Heart Rhythm Society
Perspective from Kevin Heist, MD
June 09, 2014
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MINERVA: Managed atrial, ventricular pacing reduced AF development in bradycardia

Perspective from Kevin Heist, MD
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SAN FRANCISCO — An advanced pacing feature was associated with reduced development and progression of persistent atrial fibrillation in patients with bradycardia, according to new data from the MINERVA study.

Researchers assigned patients with bradycardia and dual-chamber pacemakers who had a history of paroxysmal or persistent AF or atrial tachyarrhythmias (AT/AF) to standard dual-chamber pacing (n=385), managed ventricular pacing (n=398) or atrial preventive pacing and atrial antitachycardia pacing plus managed ventricular pacing (Reactive ATP, Medtronic; n=383).

At 2 years, incidence of persistent AT/AF was 26% (95% CI, 22-31) in the standard pacing group, 25% (95% CI, 21-30) in the managed ventricular pacing group and 15% (95% CI, 12-20) in the Reactive ATP group (HR for Reactive ATP vs. standard pacing=0.52; P<.001; HR for Reactive ATP vs. managed ventricular pacing=0.57; P=.002), according to results presented at the Heart Rhythm Society Annual Scientific Sessions.

High efficacy of Reactive ATP (>44%) was an independent predictor of reduced persistent AT/AF (HR=0.42; 95% CI, 0.21-0.83), according to Luigi Padeletti, PhD, from the University of Florence, Italy.

Compared with those in the standard pacing group, those in the Reactive ATP group showed a 58% relative reduction in the development of persistent AF and a 52% relative reduction in AF-related hospitalizations and ED visits (P<.001 for both), according to a Medtronic press release.

“Surprisingly, many episodes we thought to be AF actually start or periodically evolve into slower, more regular rhythms,” Padeletti stated in the release. “By effectively terminating those rhythms, Reactive ATP appears to be the primary pacing feature significantly delaying AF progression in patients with Medtronic pacemakers.” – by Erik Swain

For more information:

Padeletti L. Abstract LB03-06. Presented at: Heart Rhythm Society Annual Scientific Sessions; May 7-10, 2014; San Francisco.

Disclosure: Padeletti reports receiving research grants from Boston Scientific, Medtronic and St. Jude Medical.