Atrial Antitachycardia Pacing and Managed Ventricular Pacing Reduce the Endpoint Composed by Death, Cardiovascular Hospitalizations, and Permanent Atrial Fibrillation - Minerva Randomized Study

Nov 18, 2013
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Author/Summarized by Author:
Anthony A. Bavry, MD, MPH, FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Date Presented:
01/01/2013
Date Updated:
11/18/2013
Original Posted Date:
11/18/2013
References

Description:

The goal of the trial was to evaluate atrial anti-tachycardia pacing (DDDRP) and managed ventricular pacing (MVP) among patients with bradycardia and previous atrial tachyarrhythmia.

Hypothesis:

DDDRP and MVP will reduce atrial fibrillation occurrence and minimize right ventricular detrimental effects.

Study Design

  • Randomized
  • Parallel

Patient Populations:

  • Patients with bradycardia and prior atrial tachyarrhythmia

    Number of enrollees: 1,166 patients
    Mean patient age: 74 years
    Percentage female: 50%

Primary Endpoints:

  • Death, cardiovascular hospitalization, or permanent atrial fibrillation

Drug/Procedures Used:

Patients with bradycardia and previous atrial tachyarrhythmia who recently underwent permanent pacemaker placement were randomized to DDDR (n = 385), vs. DDDRP + MVP (n = 383), vs. MVP (n = 398).

Principal Findings:

Overall, 1,166 patients were randomized. The mean age was 74 years, and 50% were women.

The primary outcome occurred in 26.5% of the DDDR control group, 19.8% of the DDDRP + MVP group (p = 0.04 vs. control), and 21.4% of the MVP group (p = 0.12 vs. control).

DDDRP + MVP was associated with a reduction in permanent atrial fibrillation (hazard ratio = 0.39, p = 0.004).

Interpretation:

Among patients with bradycardia and atrial tachyarrhythmia, the pacer mode DDDRP + MVP was superior at reducing composite cardiovascular outcomes compared with standard dual-chamber pacing. This was mainly due to prevention of permanent atrial fibrillation.

References:

Presented by Dr. Giuseppe Boriani at the American Heart Association Scientific Sessions, Dallas, TX, November 18, 2013.

Keywords: Pacemaker, Artificial, Bradycardia, Heart Ventricles, Tachycardia


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