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Atrial pacing should be used more frequently in sinus node disease
Ian G Tripp1, Guy P Armstrong, James T Stewart
1Green Lane and North Shore Hospitals, Auckland, New Zealand.
Pacing and Clinical Electrophysiology : PACE
|April 14, 2005
Summary
Single lead atrial pacing (AAI(R)) is a cost-effective option for sick sinus syndrome. Patients without left bundle branch block or prolonged PR interval are ideal candidates, avoiding unnecessary ventricular pacing.
Area of Science:
- Cardiology
- Biomedical Engineering
- Clinical Electrophysiology
Background:
- Single lead atrial (AAI(R)) pacing offers physiological pacing and cost benefits over dual-chamber systems for sick sinus syndrome.
- It preserves normal cardiac depolarization, reducing atrial fibrillation, heart failure, and pacemaker syndrome compared to ventricular pacing.
Purpose of the Study:
- To identify patient selection criteria for AAI(R) pacing with a low risk of subsequent ventricular lead insertion.
- To evaluate the cost-effectiveness of this patient selection strategy.
Main Methods:
- Retrospective review of AAI(R) pacemaker implantations.
- Comparison of patients who required ventricular lead insertion versus those who remained solely atrially paced.
Main Results:
- 12% of patients required ventricular lead insertion during a median follow-up of 3.5 years.
- Pre-existing PR interval >0.20 seconds (OR 7.8) and left bundle branch block (LBBB, OR 17) significantly increased the likelihood of needing ventricular pacing.
- AAIR implantation strategy, excluding patients with LBBB or PR interval >0.20 seconds, reduced costs by 20% compared to routine dual-chamber pacing.
Conclusions:
- AAIR pacing is appropriate for sick sinus syndrome patients without LBBB or a PR interval >0.20 seconds.
- This selective approach is cost-effective and minimizes the need for additional procedures.