Pacing algorithms for suppression of atrial fibrillation Title of Trial
Atrial Dynamic Overdrive Pacing Trial (ADOPT)
Date and Citation of Primary Publication(s) or References
Carlson MD, Ip J, Messenger J, et al. A new pacemaker algorithm for the treatment of atrial fibrillation: Results of the atrial dynamic overdrive pacing trial (ADOPT). J Am Coll Card 2003; 42: 627-33.
Purpose of the Trial
Evaluate the effects of atrial overdrive pacing algorithms in patients with paroxysmal atrial fibrillation.
Study Category
Pacing & Atrial Fibrillation
Patient Population
Inclusion Criteria
Patients were eligible if they had sinus node dysfunction with a class I indication for permanent pacing and symptomatic persistent or paroxysmal atrial fibrillation with at least two symptomatic episodes in the month preceding implant on a stable antiarrhythmic drug and/or atrioventricular blocking drug and at least one electrocardiographically documented episode in the 12 weeks preceding implant.
Exclusion Criteria
Cardiac surgery in the last six months or expected cardiac surgery during the 6 month study period.
Study Design
Randomized controlled trial. After implantation, patients were randomized to specialized atrial pacing algorithms on or off.
Primary Endpoints
Symptomatic atrial fibrillation burden (number of days with an atrial fibrillation episode/ number of days of follow-up) and adverse events.
Secondary Endpoints
Number of symptomatic atrial fibrillation episodes, hospitalizations, cardioversions, and quality-of-life.
Baseline Characteristics
Patient number: 319 patients
Mean Age: 71 ± 10 years
Gender: 49% female
Other characteristics: 3-3.5 documented atrial fibrillation episodes in the 12 weeks prior to implant.
Time to Follow-up
Six month follow-up.
Results
Antiarrhythmic drug use remained similar at baseline and during follow-up for both groups. Atrial pacing reduced symptomatic atrial fibrillation burden (On: 1.9% vs. Off: 2.5%). Symptomatic atrial fibrillation burden decreased over time for both groups. No significant difference was noted in the number of atrial fibrillation episodes (On: 3.2 ± 8.6 vs. Off: 4.3 ± 11.5) or total hospitalizations (On: 9% vs. Off: 13%) between the two groups. Quality-of-life improved in both groups.
| | AF suppression algorithm "Off"
(n=158) | AF suppression algorithm "On"
(n=130) | P |
Atrial fibrillation burden
1 months
3 months
6 months |
4.4%
2.6%
1.7% |
3.2%
1.9%
1.4% | 0.005
|
| Symptomatic atrial fibrillation episodes | 51% | 56% | NS |
| Duration of mode switching (h) | 1,112 | 1,209 | NS |
| Hospitalizations | 9% | 13% | NS |
Sponsor St. Jude Medical Trial Status: Completed
