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.
|
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) |
|
This article has been cited by other articles:
|
|
|
|
 
R. A. Gebauer, V. Tomek, P. Kubus, V. Razek, T. Matejka, A. Salameh, M. Kostelka, and J. Janousek
Differential effects of the site of permanent epicardial pacing on left ventricular synchrony and function in the young: implications for lead placement
Europace,
December 1, 2009;
11(12):
1654 - 1659.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Proclemer, M. Ghidina, D. Gregori, D. Facchin, L. Rebellato, E. Zakja, M. Gulizia, and P. Esente
Trend of the main clinical characteristics and pacing modality in patients treated by pacemaker: data from the Italian Pacemaker Registry for the quinquennium 2003-07
Europace,
November 9, 2009;
(2009)
eup346v1.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Silberbauer, R. A. Veasey, N. Freemantle, A. Arya, L. Boodhoo, and N. Sulke
The relationship between high-frequency right ventricular pacing and paroxysmal atrial fibrillation burden
Europace,
November 1, 2009;
11(11):
1456 - 1461.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. F. Tops, M. J. Schalij, and J. J. Bax
The effects of right ventricular apical pacing on ventricular function and dyssynchrony implications for therapy.
J. Am. Coll. Cardiol.,
August 25, 2009;
54(9):
764 - 776.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J Janousek, R A Gebauer, H Abdul-Khaliq, M Turner, L Kornyei, O Grollmuss, E Rosenthal, E Villain, A Fruh, T Paul, et al.
Cardiac resynchronisation therapy in paediatric and congenital heart disease: differential effects in various anatomical and functional substrates
Heart,
July 15, 2009;
95(14):
1165 - 1171.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. J. Jokinen, A. K. Turpeinen, O. Pitkanen, M. J. Hippelainen, and J. E.K. Hartikainen
Pacemaker Therapy After Tricuspid Valve Operations: Implications on Mortality, Morbidity, and Quality of Life.
Ann. Thorac. Surg.,
June 1, 2009;
87(6):
1806 - 1814.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. A. Gebauer, V. Tomek, A. Salameh, J. Marek, V. Chaloupecky, R. Gebauer, T. Matejka, P. Vojtovic, and J. Janousek
Predictors of left ventricular remodelling and failure in right ventricular pacing in the young
Eur. Heart J.,
May 1, 2009;
30(9):
1097 - 1104.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. M. Fored, F. Granath, F. Gadler, P. Blomqvist, J. Rynder, C. Linde, A. Ekbom, and M. Rosenqvist
Atrial vs. dual-chamber cardiac pacing in sinus node disease: a register-based cohort study
Europace,
July 1, 2008;
10(7):
825 - 831.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. O. Sweeney and F. W. Prinzen
Ventricular Pump Function and Pacing: Physiological and Clinical Integration
Circ Arrhythm Electrophysiol,
June 1, 2008;
1(2):
127 - 139.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. M. Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, D. L. Hayes, et al.
ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons
J. Am. Coll. Cardiol.,
May 27, 2008;
51(21):
e1 - e62.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Writing Committee Members, A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. M. Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, et al.
ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons
Circulation,
May 27, 2008;
117(21):
e350 - e408.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Quesada, G. Botto, A. Erdogan, M. Kozak, P. Lercher, J. C. Nielsen, O. Piot, R. Ricci, C. Weiss, D. Becker, et al.
Managed ventricular pacing vs. conventional dual-chamber pacing for elective replacements: the PreFER MVP study: clinical background, rationale, and design
Europace,
March 1, 2008;
10(3):
321 - 326.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. E. Albertsen, J. C. Nielsen, S. H. Poulsen, P. T. Mortensen, A. K. Pedersen, P. S. Hansen, H. K. Jensen, and H. Egeblad
Biventricular pacing preserves left ventricular performance in patients with high-grade atrio-ventricular block: a randomized comparison with DDD(R) pacing in 50 consecutive patients
Europace,
March 1, 2008;
10(3):
314 - 320.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. E. Albertsen, J. C. Nielsen, S. H. Poulsen, P. T. Mortensen, A. K. Pedersen, P. S. Hansen, H. K. Jensen, and H. Egeblad
DDD(R)-pacing, but not AAI(R)-pacing induces left ventricular desynchronization in patients with sick sinus syndrome: tissue-Doppler and 3D echocardiographic evaluation in a randomized controlled comparison
Europace,
February 1, 2008;
10(2):
127 - 133.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Adachi, O. Igawa, A. Yano, J. Miake, Y. Inoue, K. Ogura, M. Kato, K. Iitsuka, and I. Hisatome
Long-term reliability of AAI mode pacing in patients with sinus node dysfunction and low Wenckebach block rate
Europace,
February 1, 2008;
10(2):
134 - 137.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Milasinovic, K. Tscheliessnigg, A. Boehmer, V. Vancura, A. Schuchert, J. Brandt, C. Wiggenhorn, M. Hofman, and J. Sperzel
Percent ventricular pacing with managed ventricular pacing mode in standard pacemaker population
Europace,
February 1, 2008;
10(2):
151 - 155.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. M. Kavanagh, I. Belenkie, and H. J. Duff
Transmural temporospatial left ventricular activation during pacing from different sites: potential implications for optimal pacing
Cardiovasc Res,
January 1, 2008;
77(1):
81 - 88.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. C. Wang, R. Passman, J. J. Goldberger, M. O. Sweeney, and G. A. Lamas
Minimizing Ventricular Pacing in Sinus-Node Disease
N. Engl. J. Med.,
December 27, 2007;
357(26):
2733 - 2734.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A.J. Camm, N. Sulke, N. Edvardsson, P. Ritter, B.A. Albers, J.H. Ruiter, T. Lewalter, P.A. Capucci, E. Hoffmann, and on behalf of the AFTherapy investigators
Conventional and dedicated atrial overdrive pacing for the prevention of paroxysmal atrial fibrillation: the AFTherapy study
Europace,
December 1, 2007;
9(12):
1110 - 1118.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Authors/Task Force Members, P. E. Vardas, A. Auricchio, J.-J. Blanc, J.-C. Daubert, H. Drexler, H. Ector, M. Gasparini, C. Linde, F. B. Morgado, et al.
Guidelines for cardiac pacing and cardiac resynchronization therapy: The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in Collaboration with the European Heart Rhythm Association
Europace,
October 1, 2007;
9(10):
959 - 998.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. O. Sweeney, A. J. Bank, E. Nsah, M. Koullick, Q. C. Zeng, D. Hettrick, T. Sheldon, G. A. Lamas, and the Search AV Extension and Managed Ventricular Pa
Minimizing Ventricular Pacing to Reduce Atrial Fibrillation in Sinus-Node Disease
N. Engl. J. Med.,
September 6, 2007;
357(10):
1000 - 1008.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Authors/Task Force Members, P. E. Vardas, A. Auricchio, J.-J. Blanc, J.-C. Daubert, H. Drexler, H. Ector, M. Gasparini, C. Linde, F. B. Morgado, et al.
Guidelines for cardiac pacing and cardiac resynchronization therapy: The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in Collaboration with the European Heart Rhythm Association
Eur. Heart J.,
September 2, 2007;
28(18):
2256 - 2295.
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. Sulke, J. Silberbauer, L. Boodhoo, N. Freemantle, K. Kamalvand, S. O'Nunain, D. Hildick-Smith, G. W. Lloyd, N. R. Patel, and V. Paul
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
Europace,
September 1, 2007;
9(9):
790 - 797.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Olshansky, J. D. Day, S. Moore, L. Gering, M. Rosenbaum, M. McGuire, S. Brown, and D. R. Lerew
Is Dual-Chamber Programming Inferior to Single-Chamber Programming in an Implantable Cardioverter-Defibrillator?: Results of the INTRINSIC RV (Inhibition of Unnecessary RV Pacing With AVSH in ICDs) Study
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]
|
|
|
|
