New data presented as a late-breaking clinical trial at the Heart Rhythm Society’s 2014 Annual Scientific Sessions (7–10 May; San Francisco, USA) has shown that an advanced pacing feature exclusive to Medtronic pacemakers significantly delays the progression of persistent atrial fibrillation (AF) in patients with bradycardia. Results from the MINERVA (Minimize right ventricular pacing to prevent atrial fibrillation and heart failure) study found that the Reactive ATP algorithm reduced the development of persistent AF by a 58% relative reduction compared to standard pacemakers (p<0.001).
The Reactive ATP algorithm, which restores the heart back to its normal rhythm by pacing during abnormally fast atrial rhythms, played a key role in slowing the progression of the disease by successfully terminating atrial tachycardia/atrial fibrillation episodes. Patients benefiting from the advanced pacing also showed a 52% relative reduction (p<0.001) in atrial fibrillation-related hospitalisations and emergency room visits.
“Atrial fibrillation is one of the most common and costly diseases, putting patients worldwide at a higher risk of heart failure, stroke and death,” says Luigi Padeletti, professor of cardiology at the University of Florence, Florence, Italy, and principal investigator of the MINERVA study. “Surprisingly, many episodes we thought to be AF actually either start or periodically evolve into slower, more regular rhythms. By effectively terminating these rhythms, Reactive ATP appears to be the primary pacing feature significantly delaying AF progression in patients with Medtronic pacemakers.”
Recently published online in the European Heart Journal, MINERVA is the first study to find that the full suite of Medtronic advanced pacing features delays the progression of permanent atrial fibrillation. Beyond the Reactive ATP algorithm, which was found to have the greatest impact in delaying disease progression, the study also evaluated the effects of the following pacing algorithms:
- MVP (managed ventricular pacing) algorithm, which promotes physiologic heart rhythms, thereby reducing the risks associated with unnecessary pacing in the right ventricle.
- Atrial Intervention Pacing, atrial overdrive pacing designed to counteract potential atrial tachyarrhythmia initiating events.
The randomised and prospective study evaluated 1,166 patients across 63 centres in Europe, the Middle East and Asia. Patients had standard indications for dual-chamber pacing and prior atrial tachyarrhythmias and were without complete heart block or permanent atrial fibrillation. Patients in the control arm were evaluated without the advanced pacing features turned on. The MVP and Reactive ATP algorithms evaluated in the MINERVA study are exclusively available on the Medtronic Advisa and Revo MRI SureScan pacing systems.