[Pacing mode influence on morbidity and mortality]

Area of Science:

• Cardiology
• Biomedical Engineering
• Clinical Trials

Context:

• Physiologic pacing (atrial or atrioventricular synchronous pacing) is hypothesized to improve cardiovascular outcomes.
• Ventricular pacing is a common alternative pacing mode.
• Previous studies suggested benefits of physiologic pacing over ventricular pacing.

Purpose:

• To review data from three large prospective trials (PASE, CTOPP, MOST) comparing physiologic pacing to ventricular pacing.
• To evaluate the impact of pacing mode on cardiac morbidity, mortality, and quality of life.

Summary:

• Physiologic pacing demonstrated a reduced risk of chronic atrial fibrillation and improved quality of life in patients with sinus node disease.
• However, these trials did not show a significant reduction in heart failure, thromboembolism, or cardiac death with physiologic pacing compared to ventricular pacing.
• Physiologic pacing is not indicated for patients with a short life expectancy based on current evidence.

Impact:

• Physiologic pacing should be considered for younger patients (<75 years), those likely to be pacemaker dependent, and patients where maintaining sinus rhythm is crucial (e.g., ventricular hypertrophy, diastolic dysfunction).
• These findings refine recommendations for pacemaker selection based on patient-specific factors and expected benefits.