CLINICAL RESEARCH: CLINICAL TRIAL
A randomized comparison ofatrial and dual-chamber pacing in177 consecutive patients with sick sinus syndrome
Echocardiographic and clinical outcome
Jens C. Nielsen, MD, PhD*,
Lene Kristensen, MD*,
Henning R. Andersen, MD, DMSc*,*,
Peter T. Mortensen, MD*,
Ole L. Pedersen, MD, DMSc and
Anders K. Pedersen, MD, DMSc*
* Department of Cardiology, Skejby Hospital, Aarhus University Hospital, Aarhus, Denmark
Department of Medicine, Viborg County Hospital, Viborg, Denmark
Manuscript received October 2, 2002;
revised manuscript received January 6, 2003,
accepted January 30, 2003.
* Reprint requests and correspondence: Dr. Henning R. Andersen, Department of Cardiology, Skejby Hospital, University of Aarhus, Brendstrupgaardsvej, 8200 Aarhus N, Denmark.
henning.rud.andersen{at}dadlnet.dk
OBJECTIVES: A randomized trial was done to compare single-chamber atrial (AAI) and dual-chamber (DDD) pacing in patients with sick sinus syndrome (SSS). Primary end points were changes in left atrial (LA) size and left ventricular (LV) size and function as measured by M-mode echocardiography.
BACKGROUND: In patients with SSS and normal atrioventricular conduction, it is still not clear whether the optimal pacing mode is AAI or DDD pacing.
METHODS: A total of 177 consecutive patients (mean age 74 ± 9 years, 73 men) were randomized to treatment with one of three rate-adaptive (R) pacemakers: AAIR (n = 54), DDDR with a short atrioventricular delay (n = 60) (DDDR-s), or DDDR with a fixed long atrioventricular delay (n = 63) (DDDR-l). Before pacemaker implantation and at each follow-up, M-mode echocardiography was done to measure LA and LV diameters. Left ventricular fractional shortening (LVFS) was calculated. Analysis was on an intention-to-treat basis.
RESULTS: Mean follow-up was 2.9 ± 1.1 years. In the AAIR group, no significant changes were observed in LA or LV diameters or LVFS from baseline to last follow-up. In both DDDR groups, LA diameter increased significantly (p < 0.05), and in the DDDR-s group, LVFS decreased significantly (p < 0.01). Atrial fibrillation was significantly less common in the AAIR group, 7.4% versus 23.3% in the DDDR-s group versus 17.5% in the DDDR-l group (p = 0.03, log-rank test). Mortality, thromboembolism, and congestive heart failure did not differ between groups.
CONCLUSIONS: During a mean follow-up of 2.9 ± 1.1 years, DDDR pacing causes increased LA diameter, and DDDR pacing with a short atrioventricular delay also causes decreased LVFS. No changes occur in LA or LV diameters or LVFS during AAIR pacing. Atrial fibrillation is significantly less common during AAIR pacing.
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Abbreviations and Acronyms
| | AAI(R) | | single-chamber atrial pacemaker(R indicates rate-adaptive pacing) | | AF | | atrial fibrillation | | AV | | atrioventricular | | DDD | | dual-chamber pacemaker | | DDDR-l | | dual-chamber pacemaker programmed with a conventional fixed long AV delay of 300 ms | | DDDR-s | dual-chamber pacemaker programmed with a conventional short rate-adaptive AV delay of  150 ms | | HF | | heart failure | | LA | | left atrial | | LV | | left ventricular | | LVED | | left ventricular end-diastolic | | LVES | | left ventricular end-systolic | | LVEF | | left ventricular ejection fraction | | LVFS | | left ventricular fractional shortening | | NYHA | | New York Heart Association | | RV | | right ventricular | | SSS | | sick sinus syndrome | | VVI(R) | | single-chamber ventricular pacemaker(R indicates rate-adaptive pacing) |
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51(21):
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|
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|
|
|
|
|
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10(3):
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|
|
|
|
|
|
|
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|
|
|
|
|
|
|
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10(2):
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|
|
|
|
|
|
|
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February 1, 2008;
10(2):
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|
|
|
|
|
|
|
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77(1):
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|
|
|
|
|
|
|
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N. Engl. J. Med.,
December 27, 2007;
357(26):
2733 - 2734.
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|
|
|
|
|
|
|
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|
|
|
|
|
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|
|
|
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|
|
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|
|
|
|
|
|
|
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|
|
|
|
|
|
|
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The use of atrial overdrive and ventricular rate stabilization pacing algorithms for the prevention and treatment of paroxysmal atrial fibrillation: the Pacemaker Atrial Fibrillation Suppression (PAFS) study
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September 1, 2007;
9(9):
790 - 797.
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|
|
|
|
|
|
|
B. Olshansky, J. D. Day, S. Moore, L. Gering, M. Rosenbaum, M. McGuire, S. Brown, and D. R. Lerew
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Circulation,
January 2, 2007;
115(1):
9 - 16.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Schmidt, J. Bromsen, C. Herholz, K. Adler, F. Neff, C. Kopf, and M. Block
Evidence of left ventricular dyssynchrony resulting from right ventricular pacing in patients with severely depressed left ventricular ejection fraction
Europace,
January 1, 2007;
9(1):
34 - 40.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H.-F. Tse and C.-P. Lau
Clinical Trials for Cardiac Pacing in Bradycardia: The End or the Beginning?
Circulation,
July 4, 2006;
114(1):
3 - 5.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. S. Healey, W. D. Toff, G. A. Lamas, H. R. Andersen, K. E. Thorpe, K. A. Ellenbogen, K. L. Lee, A. M. Skene, E. B. Schron, J. D. Skehan, et al.
Cardiovascular Outcomes With Atrial-Based Pacing Compared With Ventricular Pacing: Meta-Analysis of Randomized Trials, Using Individual Patient Data
Circulation,
July 4, 2006;
114(1):
11 - 17.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Azzolini, G. Critelli, V. De Giorgi, G. B. Del Giudice, G. Ibba, D. Melissano, A. Scaccia, and A. Puglisi
Atrial tachyarrhythmia burden modelling by some electrophysiological parameters in pacemaker-recipient patients with Brady-Tachy syndrome
Europace,
July 1, 2006;
8(7):
474 - 481.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Occhetta, M. Bortnik, A. Magnani, G. Francalacci, C. Piccinino, L. Plebani, and P. Marino
Prevention of Ventricular Desynchronization by Permanent Para-Hisian Pacing After Atrioventricular Node Ablation in Chronic Atrial Fibrillation: A Crossover, Blinded, Randomized Study Versus Apical Right Ventricular Pacing
J. Am. Coll. Cardiol.,
May 16, 2006;
47(10):
1938 - 1945.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. O. Sweeney and A. S. Hellkamp
Heart Failure During Cardiac Pacing
Circulation,
May 2, 2006;
113(17):
2082 - 2088.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Padeletti and N. Musilli
Pacemaker selection: time for a rethinking of complex pacing systems: reply
Eur. Heart J.,
May 1, 2006;
27(9):
1127 - 1127.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Z. Goldberger and R. Lampert
Implantable Cardioverter-Defibrillators: Expanding Indications and Technologies
JAMA,
February 15, 2006;
295(7):
809 - 818.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Frohlig, D. Gras, J. Victor, P. Mabo, D. Galley, A. Savoure, G. Jauvert, P. Defaye, P. Ducloux, and A. Amblard
Use of a new cardiac pacing mode designed to eliminate unnecessary ventricular pacing.
Europace,
February 1, 2006;
8(2):
96 - 101.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. W. Israel
The role of pacing mode in the development of atrial fibrillation.
Europace,
February 1, 2006;
8(2):
89 - 95.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. O. Sweeney and F. W. Prinzen
A New Paradigm for Physiologic Ventricular Pacing
J. Am. Coll. Cardiol.,
January 17, 2006;
47(2):
282 - 288.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. Musilli and L. Padeletti
Pacemaker selection: time for a rethinking of complex pacing systems?
Eur. Heart J.,
January 2, 2006;
27(2):
132 - 135.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Kashani and S. S. Barold
Significance of QRS Complex Duration in Patients With Heart Failure
J. Am. Coll. Cardiol.,
December 20, 2005;
46(12):
2183 - 2192.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. M. Dubin
Resynchronization in Pediatrics: Who Needs It?
J. Am. Coll. Cardiol.,
December 20, 2005;
46(12):
2290 - 2291.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M E Marketou, E N Simantirakis, D Nikitovic, S I Chrysostomakis, E A Zacharis, and P E Vardas
Impact of asynchronous ventricular activation on pro-inflammatory cytokines and oxidative stress in paced patients
Heart,
June 1, 2005;
91(6):
817 - 818.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. P. Knight, B. J. Gersh, M. D. Carlson, P. A. Friedman, R. L. McNamara, S. A. Strickberger, H. F. Tse, A. L. Waldo, and for the AHA Writing Group
Role of Permanent Pacing to Prevent Atrial Fibrillation: Science Advisory From the American Heart Association Council on Clinical Cardiology (Subcommittee on Electrocardiography and Arrhythmias) and the Quality of Care and Outcomes Research Interdisciplinary Working Group, in Collaboration With the Heart Rhythm Society
Circulation,
January 18, 2005;
111(2):
240 - 243.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Biffi, G. Boriani, M. Bertini, P. Silvestri, C. Martignani, and A. Branzi
Pacing with capture verification in candidates for resynchronisation therapy: A feasibility study
Europace,
January 1, 2005;
7(3):
255 - 265.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. G. Williams, D. T. Connelly, M. Jackson, A. Bennett, K. Albouaini, and D. M. Todd
Does treatment with ACE inhibitors or angiotensin II receptor antagonists prevent atrial fibrillation after dual chamber pacemaker implantation?
Europace,
January 1, 2005;
7(6):
554 - 559.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. Preumont, J.-L. Jansens, G. Berkenboom, P. van de Borne, E. Stoupel, and S. Goldman
Effects of right ventricular pacing on regional myocardial glucose metabolism
Europace,
January 1, 2005;
7(6):
584 - 591.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. R. Andersen and J. C. Nielsen
Single-lead ventricular pacing is no longer an option for sick sinus syndrome
J. Am. Coll. Cardiol.,
June 2, 2004;
43(11):
2072 - 2074.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J S Healey, E Crystal, and S J Connolly
Physiologic pacing: where pacing mode selection reflects the indication
Heart,
June 1, 2004;
90(6):
593 - 594.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L Kristensen, J C Nielsen, P T Mortensen, O L Pedersen, A K Pedersen, and H R Andersen
Incidence of atrial fibrillation and thromboembolism in a randomised trial of atrial versus dual chamber pacing in 177 patients with sick sinus syndrome
Heart,
June 1, 2004;
90(6):
661 - 666.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. G. Stevenson and M. O. Sweeney
Single Site Left Ventricular Pacing for Cardiac Resynchronization
Circulation,
April 13, 2004;
109(14):
1694 - 1696.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. R.J. Mitchell and N. Sulke
How do atrial pacing algorithms prevent atrial arrhythmias?
Europace,
January 1, 2004;
6(4):
351 - 362.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Masumoto, Y. Ueda, R. Kato, A. Usui, T. Maseki, Y. Takagi, and M. Usui
Long-term clinical performance of AAI pacing in patients with sick sinus syndrome: a comparison with dual-chamber pacing
Europace,
January 1, 2004;
6(5):
444 - 450.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Santini and R. Ricci
Atrial fibrillation and heart failure
Europace,
January 1, 2003;
5(s1):
S55 - S59.
[Full Text]
[PDF]
|
|
|
|
