Reactive ATP and MINERVA Results
The MINERVA trial demonstrated that in pacemaker patients with a history of atrial tachyarrhythmias, DDDRP + MVP proved superior to standard dual chamber pacing. The 2-year incidence of the primary endpoint (death, cardiovascular hospitalizations, or permanent AF) was significantly lowered through the reduction of the progression of atrial tachyarrhythmias to long-lasting and permanent AF over 2 years of follow- up.1 Enrolled patients had standard indications for dual-chamber pacing and prior atrial tachyarrhythmias and were without complete heart block or permanent AF.
The study found that DDDRP (dual chamber pacing with rate response and antitachycardia pacing) +MVP patients experienced a 26 percent reduced incidence (p=0.04) of the composite endpoint compared to standard paced patients. The effects of DDDRP+MVP were primarily driven by the 61 percent relative risk reduction in the progression to permanent AF (p=0.004).1
Managed ventricular pacing alone did not significantly reduce incidence of AF or of the composite endpoint, compared with the Control DDDR group. DDDRP + MVP was superior to MVP alone in reducing long lasting and permanent AF. Our interpretation of these results is that the combined effect of MVP and aATP therapies prevented the progression of atrial tachyarrhythmias to permanent AF.1
The trial observed that between the DDDRP + MVP and the Control DDDR arms at 2 years a:
26% relative reduction in all cause death, cardiovascular hospitalization, or permanent atrial fibrillation
61% relative reduction in permanent AF
52% relative reduction in AF related hospitalizations and ER visits
49% relative reduction in cardioversions for atrial arrhythmias
A new analysis of the MINERVA trial data showed that high efficacy Reactive ATP is associated with a reduction in the risk of permanent or persistent AF. Reactive ATP is a new-generation atrial ATP that attempts termination of atrial tachyarrhythmias at onset and after any change in rate or regularity when the episode may be most amenable to termination by pacing. Reactive ATP provides the opportunity to treat atrial tachyarrhythmias when they spontaneously organize or slow down.2
1Boriani G, Tukkie R, Manolis AS, Mont L, et al. Atrial antitachycardia pacing and managed ventricular pacing in bradycardia patients with paroxysmal or persistent atrial tachyarrhythmias: the MINERVA randomized multicentre international trial. Eur Heart J. 2014 Sep 14;35(35):2352-62. doi: 10.1093/eurheartj/ehu165. Epub 2014 Apr 25
2Padletti L, Pürerfellner H, et al. New-generation atrial antitachycardia pacing (Reactive ATP) is associated with reduced risk of persistent or permanent atrial fibrillation in bradycardia patients. Results from the MINERVA randomized multicenter international trial. Heart Rhythm. April 11, 2015.
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