Edinburgh Napier University

  Background/Objectives: Pacemakers detect subclinical atrial fibrillation that may be a predictor of risk of stroke. Evidence for the efficacy of algorithms for prevention and treatment of atrial fibrillation is controversial. The aim is to systematically review current evidence on the efficacy of atrial anti-tachycardia pacing (a-ATP) and atrial prevention (APP) algorithms in the reduction of atrial fibrillation (AF) burden in patients with implantable dual chamber pacemakers.

Methods: Systematic searches were made using electronic databases: Scopus and Medline Ovid using the keywords: atrial anti-tachycardia pacing, atrial ATP, pacemaker, DDD, atrial fibrillation, AF, atrial flutter, advisa, enrhythm, atrial therapy, atrial preference pacing. Secondary hand searches were performed using the reference lists of relevant articles. Controlled trials investigating the efficacy of atrial anti-tachycardia pacing (a-ATP) and/or atrial pacing prevention (APP) algorithms in pacemakers for the reduction of atrial fibrillation were included. The van Tulder score was used to assess the methodological quality of the papers.

Results: Eight papers reviewed were of good to high methodological quality. Findings were mildly in favour of the efficacy of atrial prevention (APP) algorithms and moderately against atrial anti-tachycardia pacing (a-ATP). However, when programmed in combination, there is good evidence to demonstrate a reduction in atrial fibrillation (AF) burden.

Conclusions: The findings are conflicting. Newer generation, reactive atrial anti-tachycardia pacing (a-ATP) may be promising. However, further research is needed to assess the algorithms independently and to identify the clinical characteristics of the sub-group of patients that may benefit.