Understanding consumer preferences to develop dahi using pineapple pomace powder and monk-fruit extract.

Consumer preferences refer to the subjective assessments of products and services expressed by individuals. The objective of this investigation aims to examine the preferences of consumers regarding dahi, followed by the development of a corresponding product. The initial phase of the experimental design involves understanding the interests of consumers and the variables that influence their purchasing intentions through the administration of a questionnaire. The subsequent phase entails the development of dahi in accordance with consumer preferences, followed by an assessment of its nutritional value, sensory acceptability, and storage study. Subsequently, a significant proportion of consumers (91%) expressed an interest for the introduction of a pineapple-flavour (61.5%) spoon-able dahi (77%) containing natural sugar (65%) and packaged in a cup (71.5%) within the market. To adjust the sweetness intensity of monk fruit, a series of preliminary experiments were carried out to regulate the concentration to a level that can be considered sensory acceptable, specifically 05 g/100 ml. Afterwards, dahi was prepared by altering the concentration of FPP (freeze-dried pine-apple pomace powder) within the range of 0.5 to 2.5 g/100 ml. Prepared dahi were further subjected to sensory evaluation and storage study. Based on the obtained results and sensory analyst feedback, we conclude that the dahi formulation TPM2 exhibits considerable organoleptic acceptance and also has the potential for industrial-scale production to cater wider consumer demands. Supplementary Information: The online version contains supplementary material available at 10.1007/s13197-023-05919-5.

Manufacturing and characterization of whey and stevia-based popsicles enriched with concentrated beetroot juice.

The beet-root (Beta vulgaris) and whey powder together, can potentially use as a multifunctional ingredient in the manufacturing of the "Popsicles", due to their biochemical composition that can enhance the concentration of bioactive compounds. In the present study, beet-root juice concentrates were prepared at different time/temperature treatments viz 45 °C, 55 °C, and 65 °C for 120, 80 and 45 min. The effect of different time/temperature treatments on physicochemical composition, colour, antioxidant activity (%), bioactive compounds, spectral data and sensory acceptance were evaluated. The physicochemical parameters of popsicles (PTI, PT2, PT3) including protein, total phenols, betalain, radical scavenging activity %, colour and melting values were significantly affected (p ≤ 0.05) by the different time/temperature treatments. The concentration of betalain and protein in all the popsicles ranged from 1134 to 1299 mg/L and 1.92 to 1.54 g/100 g respectively. The reduction of bioactive components viz betacyanins, betaxanthins, betanin, oxalic and syringic acid was also observed in popsicle (PTI) as compared to control. Furthermore, popsicle (PT1) was prepared with beet-root juice concentrated at 45 °C showed maximum sensory acceptance. The physicochemical and organoleptic attributes of processed popsicles encourage the commercial usage of whey powder and concentrated beetroot juice.

Red rice conjugated with barley and rhododendron extracts for new variant of beer.

This study aimed to determine the effect and potential of red rice in conjunction with barley and rhododendron extracts to develop a new variant of beer. In this study red rice, barley, and rhododendron extracts were used in different combinations and the best combination was selected based on quality and sensory characteristics. The results showed that the developed beer was rich in antioxidant activity (47.68 ± 0.96) and contained a good amount of anthocyanin (35.12 ± 0.79), flavonoids (0.119 ± 0.002), and polyphenols (0.410 ± 0.002). The red rice has more dietary significance than that of polished or milled rice, further, the use of rhododendron provides a large number of secondary metabolites such as tannins, saponins, alkaloids, tannins, and flavonoids. Besides, the sensory profile of the developed beer was quite distinct in terms of aroma, taste, and color from other alternatives available in the market.

Nourishment beyond grains: unveiling the multifaceted contributions of millets to United Nations Sustainable Development Goals.

United Nations General Assembly declared that 2023 will be celebrated as the International Year of Millets. Millets are a group of coarse grains from the Poaceae family that offer numerous benefits that align with various United Nations Sustainable Development Goals (UN SDGs). This review explores diverse contributions of millet cultivation, consumption, and value addition with UN SDGs. The millets help in combating hunger by providing economical sources of essential nutrients and diversifying diets, improving health through mitigating malnutrition and diet-related diseases. Millet's lower water demand and resilience to climatic stress help in sustainable water management. Millets reduce the risks associated with monoculture farming and promote sustainable agricultural practices. Similarly, millet plants need few chemical fertilizers, and the ecological damage associated with these plants is minimized. Millets can prevent soil degradation and conserve biodiversity. They can adapt to diverse cropping systems and support sustainable land practices. Millet cultivation reduces inequalities by empowering smallholder farmers and maintaining economic balance. The cultivation and trading of millets promote partnerships among governments, NGOs, and businesses for sustainable development. The ability of millet to contribute to poverty reduction, hunger alleviation, health improvement, environmental sustainability, and economic development makes millet a sustainable choice for a better world.

Milk from Halari Donkey Breed: Nutritional Analysis, Vitamins, Minerals, and Amino Acids Profiling.

This current research set out to characterize Halari donkey milk by investigating its nutritional constituents, including its proximate analysis, water activity, titratable acidity, energy, and microbiological analysis. A comprehensive profiling of vitamins, minerals, and amino acids was also carried out. It was found that the composition of Halari donkey milk was consistent with previously published donkey milk literature and was comparable to that of human milk. Halari donkey milk has low 0.86 ± 0.04% fat content, 2.03 ± 0.03% protein content, 0.51 ± 0.05% ash content, and high 5.75 ± 0.15% lactose content making it sweet and palatable. The energy content of Halari donkey milk was 40.39 ± 0.31 kcal/100 g, and the water activity ranged from 0.973 to 0.975. Titratable acidity was 0.03 ± 0.01%. Halari donkey milk can be considered acceptable and microbiologically safe, having low total plate count and yeast and mould counts. Mineral testing revealed that Halari donkey milk included significant amounts of magnesium, sodium, calcium, potassium, phosphorus, and zinc. The concentration of different vitamins and amino acids such as isoleucine and valine also contribute to the nutritional value of Halari donkey milk.

Fluidized Bed Drying of Wheatgrass: Effect of Temperature on Drying Kinetics, Proximate Composition, Functional Properties, and Antioxidant Activity.

Wheatgrass is a valuable source of nutrients and phytochemicals with therapeutic properties. However, its shorter life span makes it unavailable for use. So, storage-stable products must be developed through processing in order to enhance its availability. Drying is a very important part of the processing of wheatgrass. Thus, in this study, the effect of fluidized bed drying on the proximate, antioxidant, and functional properties of wheatgrass was investigated. The wheatgrass was dried in a fluidized bed drier at different temperatures (50, 55, 60, 65, 70 °C) using a constant air velocity of 1 m/s. With increasing temperature, the moisture content was reduced at a faster rate, and all drying processes took place during the falling rate period. Eight mathematical models under thin layer drying were fitted into the moisture data and were evaluated. The Page model was the most effective in explaining the drying kinetics of wheatgrass, followed by the Logarithmic model. The R2, chi-square, and root mean squared value for Page model was 0.995465-0.999292, 0.000136-0.0002, and 0.013215-0.015058, respectively. The range of effective moisture diffusivity was 1.23-2.81 × 10-10 m2/s, and the activation energy was 34.53 kJ/mol. There was no significant difference in the proximate composition of was seen at different temperatures. The total phenolic content (117.16 ± 0.41-128.53 ± 0.55 mgGAE/g), antioxidant activity (33.56 ± 0.08-37.48 ± 0.08% (DPPH), and FRAP (1.372 ± 0.001-1.617 ± 0.001 mgAAE/g) increased with the rise in temperature. A significant increase was observed in functional properties, except for the rehydration ratio, which decreased with rising temperature. The current study suggests that fluidized bed drying improves the nutritional retention of wheatgrass with good antioxidant activity and functional properties that can be used to make functional foods.

Estimating mortality and disability in Peru before the COVID-19 pandemic: a systematic analysis from the Global Burden of the Disease Study 2019.

Background: Estimating and analyzing trends and patterns of health loss are essential to promote efficient resource allocation and improve Peru's healthcare system performance. Methods: Using estimates from the Global Burden of Disease (GBD), Injuries, and Risk Factors Study (2019), we assessed mortality and disability in Peru from 1990 to 2019. We report demographic and epidemiologic trends in terms of population, life expectancy at birth (LE), mortality, incidence, prevalence, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) caused by the major diseases and risk factors in Peru. Finally, we compared Peru with 16 countries in the Latin American (LA) region. Results: The Peruvian population reached 33.9 million inhabitants (49.9% women) in 2019. From 1990 to 2019, LE at birth increased from 69.2 (95% uncertainty interval 67.8-70.3) to 80.3 (77.2-83.2) years. This increase was driven by the decline in under-5 mortality (-80.7%) and mortality from infectious diseases in older age groups (+60 years old). The number of DALYs in 1990 was 9.2 million (8.5-10.1) and reached 7.5 million (6.1-9.0) in 2019. The proportion of DALYs due to non-communicable diseases (NCDs) increased from 38.2% in 1990 to 67.9% in 2019. The all-ages and age-standardized DALYs rates and YLLs rates decreased, but YLDs rates remained constant. In 2019, the leading causes of DALYs were neonatal disorders, lower respiratory infections (LRIs), ischemic heart disease, road injuries, and low back pain. The leading risk factors associated with DALYs in 2019 were undernutrition, high body mass index, high fasting plasma glucose, and air pollution. Before the COVID-19 pandemic, Peru experienced one of the highest LRIs-DALYs rates in the LA region. Conclusion: In the last three decades, Peru experienced significant improvements in LE and child survival and an increase in the burden of NCDs and associated disability. The Peruvian healthcare system must be redesigned to respond to this epidemiological transition. The new design should aim to reduce premature deaths and maintain healthy longevity, focusing on effective coverage and treatment of NCDs and reducing and managing the related disability.

A Systematic Review of the Bioactive Components, Nutritional Qualities and Potential Therapeutic Applications of Donkey Milk.

In addition to providing individualized, specific, and ample nutritional compounds, donkey milk (DM) offers immunological modulation during health and disease. Recently, DM has attracted major interest in preparing infant formulas due to its similarity to human milk in terms of high protein and lactose content and low-fat concentration. The antimicrobial, anti-inflammation, antioxidant, and hypo-allergenicity properties of DM in human infants are well-documented. The purpose of this review is to summarize the knowledge of studies done in characterizing the composition of DM, including bioactive macronutrient levels influenced by the lactation status. The manufacture of DM-based food products and promising therapeutic applications in humans will also be discussed. The beneficial health effects of DM have been extensively studied as a valuable alternative source to breast milk. DM has proven to be a suitable nutrient to relieve milk-related allergies in human infants as opposed to cow's milk. Factors that influence the levels of macronutrients in DM include lactation status, processing, and manufacturing techniques. A wide variety of dairy products have been prepared using DM, such as cheese, ice cream, milk powder, novel functional fermented beverages, and milk powder for infant formulas. The bioactive macromolecules of DM exhibit antibacterial, antiviral, and antifungal effects as well as hypo-allergenicity, anti-inflammation, and antioxidant properties.

Recent Advances in Drumstick (Moringa oleifera) Leaves Bioactive Compounds: Composition, Health Benefits, Bioaccessibility, and Dietary Applications.

Based on the availability of many nutrients, Moringa oleifera tree leaves have been widely employed as nutrients and nutraceuticals in recent years. The leaves contain a small amount of anti-nutritional factors and are abundant in innumerable bioactive compounds. Recently, in several in vivo and in vitro investigations, moringa leaves' bioactive components and functionality are highlighted. Moringa leaves provide several health advantages, including anti-diabetic, antibacterial, anti-cancer, and anti-inflammatory properties. The high content of phytochemicals, carotenoids, and glucosinolates is responsible for the majority of these activities as reported in the literature. Furthermore, there is growing interest in using moringa as a value-added ingredient in the development of functional foods. Despite substantial study into identifying and measuring these beneficial components from moringa leaves, bioaccessibility and bioavailability studies are lacking. This review emphasizes recent scientific evidence on the dietary and bioactive profiles of moringa leaves, bioavailability, health benefits, and applications in various food products. This study highlights new scientific data on the moringa leaves containing nutrient and bioactive profiles, bioavailability, health benefits, and uses in various food items. Moringa has been extensively used as a health-promoting food additive because of its potent protection against various diseases and the widespread presence of environmental toxins. More research is needed for utilization as well as to study medicinal effects and bioaccesibility of these leaves for development of various drugs and functional foods.

Biochemical, dielectric and surface characteristics of freeze-dried bovine colostrum whey powder.

Colostrum samples of recently registered cow breed "Himachali Pahari" were assorted from high altitude zone (901-2200 m). Prepared bovine colostrum whey powder (BCWP) was analysed for chemical composition, amino acids, minerals, surface morphology (SEM-EDS), FTIR and dielectric properties. Results showed that freeze-dried BCWP contained a considerable amount of nutritional parameters viz IgG (18.55 g/100 g), protein (71.72 g/100 g) and total amino acids (69.64 g/100 g). Additionally, the concentration of essential minerals was found to be adequate, and there was no presence of heavy metals. The BCWP exhibits good dielectric properties (resistance ∼57 M-Ω). SEM-EDS showed the broken up-wards layer structure with the uniform distribution of minerals on the surface. The FTIR spectra confirmed the presence of a higher proportion of ß-sheets and ß-turn structures in BCWP. Thus, on account of good functional and nutritive properties, BCWP could be foreseen as the future of functional food.

Insights into the Research Trends on Bovine Colostrum: Beneficial Health Perspectives with Special Reference to Manufacturing of Functional Foods and Feed Supplements.

Bovine colostrum (BC) is the initial mammary secretion after parturition, which is nature's bountiful source consisting of nutritional and bioactive components present in a highly concentrated low-volume format. All mammalian newborns require colostrum to enhance physiological processes such as lifelong immunity, gastrointestinal development, and resistance to microbial infections. The genetic, environmental, and processing methods can all have an impact on the biochemical contents of BC and its supplements. BC and its derivatives have been intensively researched for their potential use in functional foods, medicines, and animal feed. Evidence from clinical studies suggests that BC products are well-tolerated, nontoxic, and safe for human ingestion. Functional foods, feed, and pharmaceutical formulations based on bovine colostrum are playing noteworthy roles in the development of innovative products for promoting health and the prevention of chronic illnesses. This systematic review sheds light on recent research on (a) the effects of processing techniques on BC components, (b) emerging techniques used in the isolation and identification of novel components, (c) BC-based functional foods for human consumption and animal feed supplements, and (d) the role of BC in current drug delivery, as well as future recommendations.

Edible Mushrooms: A Comprehensive Review on Bioactive Compounds with Health Benefits and Processing Aspects.

Mushrooms are well-known functional foods due to the presence of a huge quantity of nutraceutical components. These are well recognized for their nutritional importance such as high protein, low fat, and low energy contents. These are rich in minerals such as iron, phosphorus, as well as in vitamins like riboflavin, thiamine, ergosterol, niacin, and ascorbic acid. They also contain bioactive constituents like secondary metabolites (terpenoids, acids, alkaloids, sesquiterpenes, polyphenolic compounds, lactones, sterols, nucleotide analogues, vitamins, and metal chelating agents) and polysaccharides chiefly ß-glucans and glycoproteins. Due to the occurrence of biologically active substances, mushrooms can serve as hepatoprotective, immune-potentiating, anti-cancer, anti-viral, and hypocholesterolemic agents. They have great potential to prevent cardiovascular diseases due to their low fat and high fiber contents, as well as being foremost sources of natural antioxidants useful in reducing oxidative damages. However, mushrooms remained underutilized, despite their wide nutritional and bioactive potential. Novel green techniques are being explored for the extraction of bioactive components from edible mushrooms. The current review is intended to deliberate the nutraceutical potential of mushrooms, therapeutic properties, bioactive compounds, health benefits, and processing aspects of edible mushrooms for maintenance, and promotion of a healthy lifestyle.

A detector for a chronic implantable atrial tachyarrhythmia monitor.

Continuous long-term monitoring of atrial fibrillation (AF) and tachycardia (AT) is an unmet clinical need, which could be met with a chronically-implanted monitor. Improved therapeutic decisions based on accurate monitoring of parameters, such as daily AF/AT burden (hours/ day) may lead to improvements in clinical outcomes such as reduction in hospitalizations, symptoms, and strokes. This paper describes an AF/AT detector that detects AF as well as AT with an irregular ventricular response, and a supplementary AT detector for AT with more regular ventricular response. Seven databases with significant durations of AF, AT, and sinus rhythm were used to evaluate the performance of the detectors. All patient records with AF (N = 124) were detected by the AF/AT detector to have AF/AT burden with a mean, median, and 75 percentile of absolute error in burden detection of 8.8, 0, and 4 min, respectively. In patients having AF burden (= or > 10 min), the AF/AT detector was found to have burden accuracy within 20% of true burden in 96% of patients. The specificity was 94%, defined as follows: in patient records without AF/AT (N = 174), the percentage with AF/AT burden = or < 10 min in the 24-h recordings. The AF/AT detector underestimatesAT burden, thus degrading performance, in patients with significant amounts of AT with more regular ventricular response. The supplementary AT detector reduces the underestimation of AT while overestimating burden in patients without a significant amount of AT. The detectors described here could be implemented in an implantable monitor for accurate long-term AF/AT monitoring.

Global public health problem of sudden cardiac death.

Cardiovascular disease is a leading cause of global mortality, accounting for almost 17 million deaths annually or 30% of all global mortality. In developing countries, it causes twice as many deaths as HIV, malaria and TB combined. It is estimated that about 40-50% of all cardiovascular deaths are sudden cardiac deaths (SCDs) and about 80% of these are caused by ventricular tachyarrhythmias. Therefore, about 6 million sudden cardiac deaths occur annually due to ventricular tachyarrhythmias. The survival rate from sudden cardiac arrest is less than 1% worldwide and close to 5% in the US. Prevention of cardiovascular disease by increasing awareness of risk factors such as lack of exercise, inappropriate diet and smoking has reduced cardiovascular mortality in the US over the past few decades. However, there is still a huge cardiovascular disease burden globally as well as in the US. Therefore, there is a need to develop complementary strategies for management of sudden cardiac death. The data from several trials conclusively indicate that implantable defibrillators improve mortality in patients who have experienced an episode or are at high risk of developing ventricular tachyarrhythmias. These devices are reimbursed and are being used frequently in the developed economies for management of SCD. However, due to that low level of public and private health spending in developing economies and the relatively high cost of ICDs, their implant rates are very low there. The Automatic External Defibrillators and Emergency Medical Response Services equipped with AEDs provide complementary as well as alternative opportunities for management of SCD. There are several challenges associated with the adoption of these strategies. The efficacy and cost-effectiveness of these strategies need to be compared with ICDs to determine the appropriate strategy for various geographies. The global problem of SCD as well as the various options for its management will be discussed in the presentation.

Comparison of continuous versus intermittent monitoring of atrial arrhythmias.

BACKGROUND: The ability of intermittent or symptom-based monitoring to accurately identify patients with atrial tachycardia/atrial fibrillation (AT/AF) and to quantify AT/AF burden is not well established. OBJECTIVES: The purpose of this study was to compare intermittent and symptom-based monitoring to continuous monitoring for (1) identification of patients with any AT/AF, (2) identification of patients with long-duration AT/AF, and (3) assessment of AT/AF burden. METHODS: Data from 574 pacemaker (AT500, Medtronic) patients were analyzed retrospectively over 1 year. The device recorded the amount of AT/AF detected each day. Intermittent monitoring (annual, quarterly, and monthly 24-hour Holter; 7-day and 30-day annual long-term recordings) was simulated by analyzing data from randomly selected days within a prescribed monitoring window. Symptom-based monitoring was approximated by analyzing days when patients indicated symptoms with an external activator. RESULTS: All intermittent and symptom-based monitoring resulted in significantly lower sensitivity (range 31%-71%) and negative predictive value (range 21%-39%) for identification of patients with any AT/AF (P <.001) and underestimated AT/AF burden (P <.001) compared with continuous monitoring. Sensitivity for identifying patients with long-duration episodes ranged from 23% to 58% (P <.001 vs continuous monitoring). Identification of patients with AT/AF and assessment of AT/AF burden with intermittent monitoring depended on the patient's actual AT/AF burden and improved with increasing frequency or duration of intermittent monitoring. CONCLUSION: Intermittent and symptom-based monitoring is highly inaccurate for identifying patients with any or long-duration AT/AF and for assessing AT/AF burden. Further investigation is required to determine if full AT/AF disclosure with implantable devices is effective in reducing stroke risk and facilitating maintenance of sinus rhythm.

Management of atrial tachyarrhythmias. Rhythm control using implantable devices.

Presently, most devices with atrial diagnostic and therapeutic features are implanted in patients for electrical treatment of bradyarrhythmias and ventricular tachyarrhythmias. The painless electrical strategies for prevention and termination of ATa have not demonstrated significant clinical effectiveness in the general population with ATa. The effectiveness of ATP in reducing burden may be significantly higher in a subgroup of patients with a high incidence of stable ATa, but this needs to be evaluated prospectively. Smart sensing and detection schemes will also help provide accurate information and determine when ATa can be terminated with ATP. Although electrical defibrillation is effective, the discomfort associated with atrial shocks has limited the widespread use of this technology. Recent technological advances have increased the capabilities of implantable devices to store large amounts of diagnostic information. In the near future, implantable devices without transvenous leads may be implanted to monitor a variety of physiologic signals. This could help improve clinical outcomes and determine which therapies (pharmacologic, ablative, or electrical) would be most effective as well as monitor their safety and efficacy. Frequent monitoring from home and the availability of this data to the physician/nurse on the Internet can potentially improve the management of patients' ATa at a much lower cost.

Do atrial tachyarrhythmias beget ventricular tachyarrhythmias in defibrillator recipients?

OBJECTIVES: This study was designed to analyze the incidence of "dual tachycardia"-ventricular tachycardia (VT) or ventricular fibrillation (VF) preceded by paroxysmal atrial tachycardia (AT) or atrial fibrillation (AF)-in patients receiving dual-chamber implantable cardioverter defibrillators (ICDs). BACKGROUND: Paroxysmal AT/AF occurs commonly in patients who receive ICDs for the treatment of life-threatening VT/VF. Although AF is associated with an adverse prognosis in the setting of structural heart disease, the relationship between AT/AF and VT/VF is unclear. METHODS: We followed 537 patients undergoing implantation of the Jewel AF ICD (Model 7250, Medtronic, Minneapolis, Minnesota) for 11.4 +/- 8.2 months. These included 398 patients with a history of at least two episodes of AT or AF during the preceding year as well as 139 patients enrolled because of VT/VF alone. RESULTS: There were 233 dual tachycardia episodes in 45 patients during follow-up. Overall, 8.9% of episodes detected as VT/VF were dual tachycardias, and 20.3% of patients with VT/VF had at least one dual tachycardia episode. The median duration of AT/AF preceding the first VT/VF detection was 1.09 h (25% to 75% quartile 0.24 to 33.4 h). When AT/AF continued between two consecutive VT/VF detections, the median interdetection interval was 11 min. When AT/AF terminated either because of a ventricular therapy or spontaneously, the median interdetection interval was prolonged to 71 h (p < 0.001). CONCLUSIONS: Dual tachycardia is common in ICD recipients with a history of AT/AF. The duration of AT/AF preceding the first VT/VF detection is < or =1 h about 50% of the time. Termination of the AT/AF significantly delays the time to the next VT/VF detection.

Improved suppression of recurrent atrial fibrillation with dual-site right atrial pacing and antiarrhythmic drug therapy.

OBJECTIVES: We compared the safety, tolerance and effectiveness of overdrive high right atrial (RA), dual-site RA and support (DDI or VDI) pacing (SP) in patients with symptomatic atrial fibrillation (AF) and bradycardias. BACKGROUND: Optimal pacing methods for AF prevention remain unclear. METHODS: Patients (n = 118) were randomized to each of three pacing modes in a crossover trial. RESULTS: Mode adherence was superior for dual-site RA (5.8 months) compared with SP (3.3 months; p < 0.001) and high RA pacing (4.7 months; p = 0.006). Adverse event-free survival improved with dual-site RA (p = 0.007 vs. SP) and was comparable to high RA (p = 0. 75). AF-free survival trended to improve with dual-site RA (hazard ratio [HR] 0.715, p = 0.07 vs. SP) but not high RA (HR = 0.71, p = 0.19) or when dual-site RA was compared with high RA (HR = 0.835, p = 0.175). Time-to-recurrence was longer in dual-site RA (1.77 months) compared with high RA (0.62 months, p < 0.09) or SP (0.44 months, p < 0.05). In antiarrhythmic drug-treated patients, dual-site RA reduced recurrence risk compared with SP (HR = 0.638, p = 0.011) and high RA (HR = 0.669, p = 0.06). In patients with < or =1 AF event/week, dual-site RA improved AF suppression (HR = 0.464, p = 0.004 vs. SP; HR = 0.623, p = 0.006 vs. high RA). Dual-site RA improved AF-free and mode survival (p < 0.03 vs. high RA, p < 0.001 vs. SP) and reduced asymptomatic AF (p < 0.01 vs. high RA). CONCLUSION: Dual-site RA is safe and better tolerated than high RA and SP. In patients on antiarrhythmics, dual-site RA prolonged and high RA trended to prolong time-to-recurrent AF compared with SP. Dual-site RA provides superior symptomatic and asymptomatic AF prevention compared with high RA in patients with symptomatic AF frequency of < or =1/week.

High atrial antitachycardia pacing therapy efficacy is associated with a reduction in atrial tachyarrhythmia burden in a subset of patients with sinus node dysfunction and paroxysmal atrial fibrillation.

BACKGROUND: Atrial tachycardia (AT) and atrial flutter that occur in association with paroxysmal atrial fibrillation (AF) can be successfully terminated by antitachycardia pacing (ATP) therapy. We hypothesized that atrial ATP therapy reduces AT/AF burden in a subset of patients with symptomatic bradycardia and frequent paroxysmal AT/AF. OBJECTIVES: This study evaluated the effect of atrial ATP therapy on AT/AF burden in a pacemaker population with paroxysmal AF. METHODS: We compared AT/AF burden in 261 patients who received a Medtronic AT500 pacemaker for treatment of AT/AF in the setting of symptomatic bradycardia based on device-classified atrial ATP efficacy < 60% and > or = 60%. Patients with > or = 10 device-detected episodes of AT/AF before and after atrial ATP therapy initiation were identified from four clinical studies performed in 72 centers worldwide. RESULTS: The high efficacy group comprised 75 patients with atrial ATP efficacy > or = 60%. The low efficacy group comprised 186 patients with atrial ATP efficacy < 60%. AT/AF episode frequency was similar in both groups prior to ATP activation and decreased in the low efficacy group following ATP activation. Following atrial ATP initiation, total AT/AF burden increased slightly in the low ATP efficacy group (median 2.77 [25th-75th percentiles 0.84-5.86] hours/day vs 2.92 [0.59-8.12] hours/day, P = .01). In contrast, total AT/AF burden decreased significantly in the high efficacy group (median 2.46 [0.29-8.88] hours/day vs 0.68 [0.13-2.97] hours/day, P < .001). CONCLUSION: Up to 30% of patients with frequent episodes of paroxysmal AF and symptomatic bradycardia experience a reduction in AT/AF burden from atrial ATP therapy over time.