Reactive ATP Algorithm Cardiac Device Features


Evidence from 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 end point, composed of 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% reduced incidence (p = 0.04) of the composite end point compared to standard paced patients. The effects of DDDRP + MVP were primarily driven by the 61% 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 end point, 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 hospitalizations, 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 subsequent analysis of the data, versus 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

Reduce the Progression to Permanent AF

with Reactive ATP Algorithm

  • 61% relative reduction in the progression to Permanent AF
  • 52% relative reduction in AF-related hospitalizations in ER visits
  • 49% relative reduction of AF cardioversions

How does Reactive ATP work?

Reactive ATP allows for multiple deliveries of programmed atrial ATP therapies during an atrial tachyarrhythmia episode in response to either of the following events:

  1. Change in the atrial rhythm’s cycle length or regularity (rhythm change)
  2. The expiration of a programmed time interval (time interval)

All additional therapies in this 50 ms zone also delivered unsuccessfully.


Boriani G, et al. Eur Heart J. 2014;35:2352-2362.


Padeletti L, et al. Heart Rhythm.2015;12:1717-1725.