Abstract
BACKGROUND: 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. OBJECTIVE: This study aimed to evaluate the long-term efficacy of rATP in patients implanted with pacemakers owing to SSS and AVB. METHODS: 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]). RESULTS: 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 (P = .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, P = .036; AVB, P = .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. CONCLUSION: 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.