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Long-term outcome of single-chamber atrial pacing compared with dual-chamber pacing in patients with sinus-node

Won Ho Kim1, Boyoung Joung, Jaemin Shim

  • 1Division of Cardiology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea.

Yonsei Medical Journal
|September 30, 2010
PubMed

Insights

Single chamber atrial pacing (AAI(R)) is superior to dual chamber pacing (DDD(R)) for patients with sinus node dysfunction and intact AV conduction, reducing hospitalizations for heart failure and atrial fibrillation.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Sinus node dysfunction (SND) with intact atrioventricular (AV) conduction presents challenges in selecting optimal pacemaker mode.
  • Current guidelines lack definitive recommendations for single-chamber atrial (AAI/AAIR) versus dual-chamber (DDD/DDDR) pacing in these patients.

Purpose of the Study:

  • To compare the clinical outcomes of AAI(R) pacing versus DDD(R) pacing in patients with SND and intact AV conduction.
  • To determine the preferred pacing mode for improved patient management and reduced adverse events.

Main Methods:

  • A comparative study involving patients implanted with permanent pacemakers.
  • Analysis of outcomes in 73 patients receiving AAI(R) pacing versus 113 patients receiving DDD(R) pacing.
  • Mean follow-up duration of 69 months.

Main Results:

  • No significant difference in mortality between AAI(R) and DDD(R) groups.
  • Significantly lower hospitalization rates for congestive heart failure (CHF) in the AAI(R) group (0%) compared to the DDD(R) group (8.8%, p=0.03).
  • Lower incidence of atrial fibrillation (AF) in the AAI(R) group (2.8%) versus the DDD(R) group (15.2%, p=0.01).
  • Four patients (5.5%) in the AAI(R) group developed AV block and required conversion to DDD(R) pacing.

Conclusions:

  • AAI(R) pacing demonstrates superior clinical outcomes compared to DDD(R) pacing in patients with SND and intact AV conduction.
  • AAI(R) pacing is associated with reduced risks of CHF and AF.
  • AAI(R) pacing should be considered the preferred pacing mode for this patient population.
Abstract

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