Atrial antitachycardia pacing and atrial remodeling: a substudy of the international, randomized MINERVA trial

Abstract Background Atrial tachycardia (AT) and atrial fibrillation (AF) are common in pacemaker patients and are associated with bad prognosis. Objective To evaluate atrial antitachycardia pacing impact on AT/AF induced atrial remodeling, measured by early recurrence of AT/AF (ERAF) and by change in left atrium diameter (LAD). To evaluate impact of AT/AF duration on ERAF incidence. Methods Pacemaker patients were randomized to dual-chamber pacing (Control DDDR-385 patients), managed ventricular pacing (MVP-398 patients) or atrial antitachycardia pacing plus MVP (DDDRP+MVP-383 patients). LAD change, estimated via echocardiography, was considered significant if the relative difference between baseline and 24-month measurements was >10%. Results In a median follow-up of 34 months, ERAF incidence was significantly lower in the DDDRP+MVP arm for all AT/AF durations, in particular ERAF followed AT/AF longer than 3 hours in 53% cases in Control DDDR , in 51% cases in MVP and in 39% cases in DDDRP+MVP (p