Summary
1. This technology has been in SJM pacemakers for long enough that we know AF is not eliminated - merely reduced in amount
2. Reduction in AF burden does not translate into reduced need for anticoagulation in this high risk population
3. Reduction in AF burden does not translate into reduction in clinical end-points such as stroke
4. The AF-suppression algorithm increases heart rate significantly and may (in theory) undermine the benefits of CRT
Analysis
AF can limit effectiveness of CRT when AV block is not present - in addition to the additional morbidity and mortality associated with this arrhythmia. However, the SJM algorithm fails to address the problem.
I do not believe this will have real beneficial impact upon patient outcomes but it may have transient marketing benefit for SJM...once Ep lysicians see what is happening I believe this will be seen as the failure that it is.
If AF is to be treated properly then patients need other major approaches such as ablation (in left atrium or of AV node) or anti-arrhythmic drugs; some of these modalities may be effective when used in hybrid fashion with AF suppression but this remains to be shown in clinical trials.
