Aims: Atrial fibrillation (AF) is a common comorbidity in bradycardia patients. Advanced pacemakers feature atrial preventive pacing and atrial antitachycardia pacing (DDDRP) and managed ventricular pacing (MVP), which minimizes unnecessary right ventricular pacing. We evaluated whether DDDRP and MVP might reduce mortality, morbidity, or progression to permanent AF when compared with standard dual-chamber pacing (Control DDDR).
Methods And Results: In a randomized, parallel, single-blind, multi-centre trial we enrolled 1300 patients with bradycardia and previous atrial tachyarrhythmias, in whom a DDDRP pacemaker had recently been implanted. History of permanent AF and third-degree atrioventricular block were exclusion criteria. After a 1-month run-in period, 1166 eligible patients, aged 74 ± 9 years, 50% females, were randomized to Control DDDR, DDDRP + MVP, or MVP. Analysis was intention-to-treat. The primary outcome, i.e. the 2-year incidence of a combined endpoint composed of death, cardiovascular hospitalizations, or permanent AF, occurred in 102/385 (26.5%) Control DDDR patients, in 76/383 (19.8%) DDDRP + MVP patients [hazard ratio (HR) = 0.74, 95% confidence interval 0.55-0.99, P = 0.04 vs. Control DDDR] and in 85/398 (21.4%) MVP patients (HR = 0.89, 95% confidence interval 0.77-1.03, P = 0.125 vs. Control DDDR). When compared with Control DDDR, DDDRP + MVP reduced the risk for AF longer than 1 day (HR = 0.66, 95% CI 0.52-0.85, P < 0.001), AF longer than 7 days (HR = 0.52, 95% CI 0.36-0.73, P < 0.001), and permanent AF (HR = 0.39, 95% CI 0.21-0.75, P = 0.004).
Conclusion: In patients with bradycardia and atrial tachyarrhythmias, DDDRP + MVP is superior to standard dual-chamber pacing. The primary endpoint was significantly lowered through the reduction of the progression of atrial tachyarrhythmias to permanent AF.
Clinicaltrialsgov Identifier: NCT00262119.
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| http://dx.doi.org/10.1093/eurheartj/ehu165 | DOI Listing |
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Prevention of long-lasting atrial fibrillation through antitachycardia pacing in DDDR pacemakers.
Int J Clin Pract
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Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola University Hospital, Bologna, Italy.
Objective: The MINERVA trial showed that in pacemaker patients with atrial fibrillation (AF) history, DDDRP pacing combining three algorithms - (a) atrial antitachycardia pacing with Reactive ATP enabled, (b) atrial preventive pacing and (c) managed ventricular pacing (MVP)-may effectively delay progression to persistent/permanent AF compared with standard DDDR pacing. We performed a comparative non-randomised evaluation to evaluate if Reactive ATP can be the main driver of persistent/permanent AF reduction independently on preventive pacing.
Methods: Thirty-one centres included consecutive dual-chamber pacemaker patients with AF history.
Effect of PR interval and pacing mode on persistent atrial fibrillation incidence in dual chamber pacemaker patients: a sub-study of the international randomized MINERVA trial.
Europace
April 2019
Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S.Orsola-Malpighi University Hospital, Bologna, Italy.
Aims: Per standard of care, dual-chamber pacemakers are programmed in DDDR mode with fixed atrioventricular (AV) delay or with long AV delay to minimize ventricular pacing. We aimed to evaluate whether the PR interval may be a specific criterion of choice between standard DDDR, to preserve AV synchrony in long PR patients, and managed ventricular pacing (MVP), to avoid ventricular desynchronization imposed by right ventricle apical pacing, in short PR patients.
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Health care cost analysis of enhanced pacing modalities in bradycardia patients: Portuguese case study on the results of the MINERVA trial.
Rev Port Cardiol (Engl Ed)
December 2018
University of Florence, Florence, Italy.
Article Synopsis
- The MINERVA trial found that a combination of atrial preventive pacing (DDDRP) and managed ventricular pacing (MVP) reduces the risk of developing permanent atrial fibrillation (AF) in patients who need cardiac pacing, leading to lower health care utilization compared to traditional methods.
- In Portugal, implementing this new pacing strategy could save approximately 2,323 euros per 100 patients in the first year and 17,118 euros over ten years, totaling potential national savings of 75,369 euros annually.
- Overall, the study suggests that using DDDRP + MVP not only decreases the occurrence of recurrent AF but also has the potential to significantly reduce costs in the Portuguese health care system.
Atrial antitachycardia pacing and atrial remodeling: A substudy of the international, randomized MINERVA trial.
Heart Rhythm
October 2017
Institute of Internal Medicine and Cardiology, University of Florence, Florence, Italy; IRCCS Multimedica, Sesto San Giovanni, Italy.
Background: Atrial tachycardia (AT) and atrial fibrillation (AF) are common in pacemaker patients and are associated with bad prognoses.
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New-generation atrial antitachycardia pacing (Reactive ATP) is associated with reduced risk of persistent or permanent atrial fibrillation in patients with bradycardia: Results from the MINERVA randomized multicenter international trial.
Heart Rhythm
August 2015
Institute of Cardiology, S. Orsola-Malpighi University Hospital, Bologna, Italy. Electronic address:
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Objective: We aimed to determine the role of new-generation atrial antitachycardia pacing (Reactive ATP) in preventing AF disease progression.
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