A comparison of single-lead atrial pacing with dual-chamber pacing in sick sinus syndrome

作者：Nielsen Jens Cosedis^*; Thomsen Poul Erik B; Hojberg Soren; Moller Mogens; Vesterlund Thomas; Dalsgaard Dorthe; Mortensen Leif S; Nielsen Tonny; Asklund Mogens; Friis Elsebeth V; Christensen Per D; Simonsen Erik H; Eriksen Ulrik H; Jensen Gunnar V H; Svendsen Jesper H; Toff William D; Healey Jeffrey S; Andersen Henning R

来源：European Heart Journal, 2011, 32(6): 686-696.

DOI：10.1093/eurheartj/ehr022

• Cardiac pacing
• Sick sinus syndrome
• Single-lead atrial pacing
• Dual-chamber pacing
• Randomized controlled trial
• Outcomes

Aims In patients with sick sinus syndrome, bradycardia can be treated with a single-lead pacemaker or a dual-chamber pacemaker. Previous trials have revealed that pacing modes preserving atrio-ventricular synchrony are superior to single-lead ventricular pacing, but it remains unclear if there is any difference between single-lead atrial pacing (AAIR) and dual-chamber pacing (DDDR).
Methods and results We randomly assigned 1415 patients referred for first pacemaker implantation to AAIR (n = 707) or DDDR (n = 708) pacing and followed them for a mean of 5.4 +/- 2.6 years. The primary outcome was death from any cause. Secondary outcomes included paroxysmal and chronic atrial fibrillation, stroke, heart failure, and need for pacemaker reoperation. In the AAIR group, 209 patients (29.6%) died during follow-up vs. 193 patients (27.3%) in the DDDR group, hazard ratio (HR) 1.06, 95% confidence interval (CI) 0.88-1.29, P = 0.53. Paroxysmal atrial fibrillation was observed in 201 patients (28.4%) in the AAIR group vs. 163 patients (23.0%) in the DDDR group, HR 1.27, 95% CI 1.03-1.56, P = 0.024. A total of 240 patients underwent one or more pacemaker reoperations during follow-up, 156 (22.1%) in the AAIR group vs. 84 (11.9%) in the DDDR group (HR 1.99, 95% CI 1.53-2.59, P < 0.001). The incidence of chronic atrial fibrillation, stroke, and heart failure did not differ between treatment groups.
Conclusion In patients with sick sinus syndrome, there is no statistically significant difference in death from any cause between AAIR pacing and DDDR pacing. AAIR pacing is associated with a higher incidence of paroxysmal atrial fibrillation and a two-fold increased risk of pacemaker reoperation. These findings support the routine use of DDDR pacing in these patients. Clinical Trial Registration: URL http://www.clinicaltrials.gov. Unique identifier: NCT00236158.

• 出版日期2011-3