Ventricular pacing or dual-chamber pacing for sinus-node dysfunction.

By G. Lamas, Kerry L Lee, M. Sweeney, R. Silverman, A. León, R. Yee, R. Marinchak, G. Flaker, E. Schron, E. Orav and 9 more. New England Journal of Medicine, 2002

953 citations recorded by the source corpus.

BACKGROUND Dual-chamber (atrioventricular) and single-chamber (ventricular) pacing are alternative treatment approaches for sinus-node dysfunction that causes clinically significant bradycardia. However, it is unknown which type of pacing results in the better outcome. METHODS We randomly assigned a total of 2010 patients with sinus-node dysfunction to dual-chamber pacing (1014 patients) or ventricular pacing (996 patients) and followed them for a median of 33.1 months. The primary end point was death from any cause or nonfatal stroke. Secondary end points included the composite of death, stroke, or hospitalization for heart failure; atrial fibrillation; heart-failure score; the pacemaker syndrome; and the quality of life. RESULTS The incidence of the primary end point did not differ significantly between the dual-chamber group (21.5 percent) and the ventricular-paced group (23.0 percent, P=0.48). In patients assigned to dual-chamber pacing, the risk of atrial fibrillation was lower (hazard ratio, 0.79; 95 percent confidence interval, 0.66 to 0.94; P=0.008), and heart-failure scores were better (P<0.001). The differences in the rates of hospitalization for heart failure and of death, stroke, or hospitalization for heart failure were not significant in unadjusted analyses but became marginally significant in adjusted analyses. Dual-chamber pacing resulted in a small but measurable increase in the quality of life, as compared with ventricular pacing. CONCLUSIONS In sinus-node dysfunction, dual-chamber pacing does not improve stroke-free survival, as compared with ventricular pacing. However, dual-chamber pacing reduces the risk of atrial fibrillation, reduces signs and symptoms of heart failure, and slightly improves the quality of life. Overall, dual-chamber pacing offers significant improvement as compared with ventricular pacing.

Subfields: Cardiology and Cardiovascular Medicine

View Paper: https://www.semanticscholar.org/paper/70fdd64a2b0c5626ec1743e8247412ef954e54f9

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In Cardiology and Cardiovascular Medicine

Citations in the corpus

Adverse Effect of Ventricular Pacing on Heart Failure and Atrial Fibrillation Among Patients With Normal Baseline QRS Duration in a Clinical Trial of Pacemaker Therapy for Sinus Node Dysfunction (2003, methodology): “For each patient, cumulative percent ventricular paced (Cum%VP) from random assignment to each day of follow-up was calculated by (1) finding, for each visit, the mean percent ventricular paced over all visits up to and including that visit, weighted by the number of days between visits, and (2) usi”
ACC/AHA/HRS 2008 Guidelines for device-based therapy of cardiac rhythm abnormalities. (2008, background): “2 Quality of Life and Functional Status End Points Numerous studies have shown significant improvement in reported QOL and functional status after pacemaker implantation (22,23,285,286), but there is also a well-documented placebo effect after device implantation (222).”
2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). (2013, background): “1,12 When the correlation between symptoms and ECG is established, there is general consensus that cardiac pacing is effective and useful for symptom relief.”