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

• Published in: European heart journal 2011-03, Vol.32 (6), p.686-696
• Main Authors: COSEDIS NIELSEN, Jens, THOMSEN, Poul Erik B, 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, HØJBERG, Søren, MØLLER, Mogens, VESTERLUND, Thomas, DALSGAARD, Dorthe, MORTENSEN, Leif S, NIELSEN, Tonny, ASKLUND, Mogens, FRIIS, Elsebeth V
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Atrial Fibrillation - etiology; Atrial Fibrillation - mortality; Biological and medical sciences; Cardiac dysrhythmias; Cardiac Pacing, Artificial - methods; Cardiology. Vascular system; Cardiotonic Agents - therapeutic use; Cause of Death; Female; Follow-Up Studies; Heart; Humans; Male; Medical sciences; Middle Aged; Pacemaker, Artificial; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Reoperation - statistics & numerical data; Sick Sinus Syndrome - mortality; Sick Sinus Syndrome - therapy; Stroke - etiology; Stroke - mortality; Treatment Outcome; Young Adult
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehr022

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). 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. 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. URL http://www.clinicaltrials.gov. Unique identifier: NCT00236158.