Reactive antitachycardia pacing transforms a long-lasting persistent atrial flutter in an UN-frequent paroxysmal arrhythmia

Introduction: Heart failure (HF) and atrial fibrillation (AF) frequently coexist in the same patient and are associated with increased mortality, morbidity and quality of life impairment. The prompt treatment of AFinHF patients may significantly improve outcome. The MINERVA trial has recently shown the impact of new generation Reactive atrial antitachycardia pacing (ATP) in sinus node disease patients. Whether Reactive ATP may be effective in other patient cohorts, such as HF patients with implanted pacemakers or defibrillators or with cardiac resynchronization therapy (CRT), remains as an important unanswered question. Methods: NA Results: We report a case of a 83-year-old man, with a history of first degree AV block, hypertension, idiopathic dilatative HF, and symptomatic atrial flutter. On December 2011 he received a biventricular pacemaker and was then treated by elective AV node ablation. Pharmacological treatment, comprising warfarin, doxazosin mesylate, perindropil/indapamide, ezetimibe/simvastatina and remained unchanged for all the observation period. From August 2012 till April 2015 the patient was characterized by a long-lasting form of persistent atrial arrhythmia. On April 30 2015 Reactive ATP was enabled and the atrial arrhythmia had an immediate transition from a long-lasting persistent form to an un-frequent paroxysmal form with low daily AT/AF burden. Patient activity improved. The Trend of atrial arrhythmias is show on figure 1. Conclusions: This is the first case report showing that Reactive ATP may have a clinical impact in reversing the natural history of atrial disease progression in a HF patient wearing a CRT pacemaker. (Figure Presented).