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Atrial vs. dual-chamber cardiac pacing in sinus node disease: a register-based cohort study

C Michael Fored1, Fredrik Granath, Fredrik Gadler

  • 1Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet and Karolinska University Hospital, Site Solna M9:01, SE-171 76 Stockholm, Sweden. Michael.Fored@ki.se

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|May 10, 2008
PubMed

Insights

Atrial pacing (AAI) is preferable to dual-chamber pacing (DDD) for sinus node disease patients. AAI pacing is linked to lower cardiovascular risks and mortality compared to DDD pacing.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Device Technology

Background:

  • Sinus node disease (SND) affects heart rhythm regulation.
  • Dual-chamber pacing (DDD) is used for SND but may impact ventricular function.
  • Atrial pacing (AAI) is an alternative pacing mode for SND.

Purpose of the Study:

  • To compare cardiovascular morbidity and mortality between AAI and DDD pacing in SND patients.
  • To evaluate the safety and efficacy of different pacing modes for SND.

Main Methods:

  • A nationwide, population-based cohort study of 8777 patients with AAI or DDD pacemakers.
  • 12-year follow-up linked to national healthcare and census registers.
  • Comparison of post-implant outcomes including atrial fibrillation, cardiovascular disease, and mortality.

Main Results:

  • DDD pacing showed an increased risk of post-implant atrial fibrillation/flutter compared to AAI pacing (HR=1.30).
  • A slight increase in cardiovascular disease and all-cause mortality was observed with DDD pacing versus AAI pacing.
  • AAI pacing was associated with decreased all-cause mortality risk (SMR=0.89) compared to the general population.

Conclusions:

  • AAI pacing is recommended as the preferred mode for patients with sinus node disease and normal AV node function.
  • The findings support AAI pacing for improved long-term outcomes in SND patients.
  • DDD pacing may be associated with increased risks of atrial arrhythmias and mortality.
Abstract

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