Long-Term Outcome of Single-Chamber Atrial Pacing Compared with Dual-Chamber Pacing in Patients with Sinus-Node Dysfunction and Intact Atrioventricular Node Conduction
0
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Purpose: The optimal pacing mode with either single chamber atrial pacemaker (AAI or AAIR) or dual chamber pacemaker (DDD or DDDR) is still not clear in sinus-node dysfunction (SND) and intact atrioventricular (AV) conduction. Materials and Methods: Patients who were implanted with permanent pacemaker using AAI(R) (n = 73) or DDD(R) (n = 113) were compared. Results: The baseline characteristics were comparable between the two groups, with a mean follow-up duration of 69 months. The incidence of death did not show statistical difference. However, the incidence of hospitalization for congestive heart failure (CHF) was significantly lower in the AAI(R) group (0%) than the DDD(R) group (8.8%, p =0.03). Also, atrial fibrillation (AF) was found in 2.8% in the AAI(R) group, which was statistically different from 15.2% of patients in the DDD(R) group (p = 0.01). Four patients (5.5%) with AAI(R) developed AV block, and subsequently switched to DDD(R) pacing. The risk of AF was lower in the patients implanted with AAI(R)than those with DDD(R) [hazard ratio (HR), 0.84; 95% confidence interval, 0.72 to 0.97, p = 0.02]. Conclusion: In patients with SND and intact AV conduction,AAI(R) pacing can achieve a better clinical outcome in terms of occurrence of CHF and AF than DDD(R) pacing. These findings support AAI(R) pacing as the preferred pacing mode in patients with SND and intact AV conduction.
Abstract
Purpose: The optimal pacing mode with either single chamber atrial pacemaker (AAI or AAIR) or dual chamber pacemaker (DDD or DDDR) is still not clear in sinus-node dysfunction (SND) and intact atrioventricular (AV) conduction. Materials and Methods: Patients who were implanted with permanent pacemaker using AAI(R) (n = 73) or DDD(R) (n = 113) were compared. Results: The baseline characteristics were comparable between the two groups, with a mean follow-up duration of 69 months. The incidence of death did not show statistical difference. However, the incidence of hospitalization for congestive heart failure (CHF) was significantly lower in the AAI(R) group (0%) than the DDD(R) group (8.8%, p =0.03). Also, atrial fibrillation (AF) was found in 2.8% in the AAI(R) group, which was statistically different from 15.2% of patients in the DDD(R) group (p = 0.01). Four patients (5.5%) with AAI(R) developed AV block, and subsequently switched to DDD(R) pacing. The risk of AF was lower in the patients implanted with AAI(R)than those with DDD(R) [hazard ratio (HR), 0.84; 95% confidence interval, 0.72 to 0.97, p = 0.02]. Conclusion: In patients with SND and intact AV conduction,AAI(R) pacing can achieve a better clinical outcome in terms of occurrence of CHF and AF than DDD(R) pacing. These findings support AAI(R) pacing as the preferred pacing mode in patients with SND and intact AV conduction.
참고문헌 (23)
- Lamas GA, "Permanent pacemaker selection and subsequent survival in elderly Medicare pacemaker recipients", Circulation, 91, pp.1063~1069 (1995)
- Healey JS, "Cardiovascular outcomes with atrial-based pacing compared with ventricular pacing: meta-analysis of randomized trials, using individual patient data", Circulation, 114, pp.11~17 (2006)
- Andersen HR, "Atrioventricular conduction during longterm follow-up of patients with sick sinus syndrome", Circulation, 98, pp.1315~1321 (1998)
- Nielsen JC, "A randomized comparison of atrial and dualchamber pacing in 177 consecutive patients with sick sinus syn-drome: echocardiographic and clinical outcome", J Am Coll Cardiol, 42, pp.614~623 (2003)
- Masumoto H, "Long-term clinical performance of AAI pacing in patients with sick sinus syndrome: a comparison with dual-chamber pacing", Europace, 6, pp.444~450 (2004)
- Santini M, "Relation of prognosis in sick sinus syndrome to age, conduction defects and modes of permanent cardiac pacing", Am J Cardiol, 65, pp.729~735 (1990)
- Andersen HR, "Long-term follow-up of patients from a randomized trial of atrial versus ventricular pacing for sick-sinus syndrome", Lancet, 350, pp.1210~1216 (1997)
- Brandt J, "Natural history of sinus-node disease treated with atrial pacing in 213 patients:implications for selection of stimulation mode", J Am Coll Cardiol, 20, pp.633~639 (1992)
- Haywood GA, "Atrioventricular Wenckebach point and progression to atrioventricular block in sinoatrial disease", Pacing Clin Electrophysiol, 13, pp.2054~2058 (1990)
- Hatano K, "Usefulness of rate responsive atrial pacing in patients with sick sinus syndrome", Pacing Clin Electrophysiol, 12, pp.16~24 (1989)
- Kristensen L, "Incidence of atrial fibrillation and thromboembolism in a randomised trial of atrial versus dual chamber pacing in 177 patients with sick sinus syndrome", Heart, 90, pp.661~666 (2004)
- Leclercq C, "Hemodynamic importance of preserving the normal sequence of ventricular activation in permanent cardiac pacing", Am Heart J, 129, pp.1133~1141 (1995)
- Lee MA, "Effects of long-term right ventricular apical pacing on left ventricular perfusion, innervation, function and histology", J Am Coll Cardiol, 24, pp.225~232 (1994)
- Rosenqvist M, "Relative importance of activation sequence compared to atrioventricular synchrony in left ventricular function", Am J Cardiol, 67, pp.148~156 (1991)
- Sweeney MO, "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", Circulation, 107, pp.2932~2937 (2003)
- Shih-Hung Tsai, "Interpretation and Use of Natriuretic Peptides in Non-Congestive Heart Failure Settings", Yonsei Medical Journal, 51(2), pp.151~163 (2010), 연세대학교의과대학
- Nielsen JC, "Regional myocardial blood flow in patients with sick sinus syndrome randomized to long-term single chamber atrial or dual chamber pacing-effect of pacing mode and rate", J Am Coll Cardiol, 35, pp.1453~1461 (2000)
- Adomian GE, "Myofibrillar disarray produced in normal hearts by chronic electrical pacing", Am Heart J, 112, pp.79~83 (1986)
- van Oosterhout MF, "Asynchronous electrical activation induces asymmetrical hypertrophy of the left ventricular wall", Circulation, 98, pp.588~595 (1998)
- Connolly SJ, "Effects of physiologic pacing versus ventricular pacing on the risk of stroke and death due to cardiovascular causes. Canadian Trial of Physiologic Pacing Investigators", N Engl J Med, 342, pp.1385~1391 (2000)
- Lamas GA, "Ventricular pacing or dual-chamber pacing for sinusnode dysfunction", N Engl J Med, 346, pp.1854~1862 (2002)
- Toff WD, "Single-chamber versus dual-chamber pacing for high-grade atrioventricular block", N Engl J Med, 353, pp.145~155 (2005)
- Greenspon AJ, "Predictors of stroke in patients paced for sick sinus syndrome", J Am Coll Cardiol, 43, pp.1617~1622 (2004)