A randomized comparison ofatrial and dual-chamber pacing in177 consecutive patients with sick sinus syndrome: Echocardiographic and clinical outcome

doi:10.1016/S0735-1097(03)00757-5

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J Am Coll Cardiol, 2003; 42:614-623, doi:10.1016/S0735-1097(03)00757-5
© 2003 by the American College of Cardiology Foundation

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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 sinussyndrome (SSS). Primary end points were changes in left atrial(LA) size and left ventricular (LV) size and function as measuredby M-mode echocardiography.

BACKGROUND: In patients with SSS and normal atrioventricular conduction,it is still not clear whether the optimal pacing mode is AAIor DDD pacing.

METHODS: A total of 177 consecutive patients (mean age 74 ± 9years, 73 men) were randomized to treatment with one of threerate-adaptive (R) pacemakers: AAIR (n = 54), DDDR with a shortatrioventricular delay (n = 60) (DDDR-s), or DDDR with a fixedlong atrioventricular delay (n = 63) (DDDR-l). Before pacemakerimplantation and at each follow-up, M-mode echocardiographywas done to measure LA and LV diameters. Left ventricular fractionalshortening (LVFS) was calculated. Analysis was on an intention-to-treatbasis.

RESULTS: Mean follow-up was 2.9 ± 1.1 years. In the AAIR group,no significant changes were observed in LA or LV diameters orLVFS from baseline to last follow-up. In both DDDR groups, LAdiameter increased significantly (p < 0.05), and in the DDDR-sgroup, LVFS decreased significantly (p < 0.01). Atrial fibrillationwas significantly less common in the AAIR group, 7.4% versus23.3% in the DDDR-s group versus 17.5% in the DDDR-l group (p= 0.03, log-rank test). Mortality, thromboembolism, and congestiveheart failure did not differ between groups.

CONCLUSIONS: During a mean follow-up of 2.9 ± 1.1 years, DDDR pacingcauses increased LA diameter, and DDDR pacing with a short atrioventriculardelay also causes decreased LVFS. No changes occur in LA orLV diameters or LVFS during AAIR pacing. Atrial fibrillationis significantly less common during AAIR pacing.

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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