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Single lead atrial vs. dual chamber pacing in sick sinus syndrome: extended register-based follow-up in the DANPACE

Niels H Brandt1, Rikke Esberg Kirkfeldt2, Jens Cosedis Nielsen2

  • 1Department of Cardiology, Zealand University Hospital, Roskilde, Denmark.

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
|January 1, 2017
PubMed

Insights

Long-term follow-up of the DANPACE trial shows no significant difference in mortality between single lead atrial (AAIR) and dual chamber (DDDR) pacemakers for sick sinus syndrome. Risks of atrial fibrillation hospitalization, stroke, and heart failure also remained similar.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Device Research

Background:

  • The DANPACE trial initially compared single lead atrial (AAIR) versus dual chamber (DDDR) pacemakers for sick sinus syndrome (SSS).
  • Early follow-up revealed no survival benefit but increased risks of atrial fibrillation and reoperation with AAIR pacing.
  • Very long-term outcomes and pacing mode changes require further investigation.

Purpose of the Study:

  • To evaluate the very long-term risks of death, atrial fibrillation (AF) hospitalization, stroke, and heart failure (HF) in SSS patients randomized to AAIR or DDDR pacing.
  • To assess the rate of pacing mode changes from AAIR to DDDR over an extended follow-up period.

Main Methods:

  • Utilized national register-based data for long-term follow-up of all 1384 patients from the DANPACE trial.
  • Intention-to-treat analysis was performed on data obtained from Danish national registers.
  • Mean follow-up duration was 8.9 years.

Main Results:

  • No significant difference in overall mortality was observed between the AAIR (59.3% death) and DDDR (53.3% death) groups (adjusted hazard ratio 1.03).
  • The risk of AF hospitalization, stroke, and HF did not differ between the two pacing groups.
  • The annual rate of pacing mode change to DDDR in the AAIR group was 4.5% during extended follow-up, higher than the 2.3% during the trial.

Conclusions:

  • Very long-term follow-up confirms no significant difference in mortality between AAIR and DDDR pacing for SSS patients.
  • There is no increased long-term risk of AF hospitalization, stroke, or HF with either pacing mode.
  • The increased rate of pacing mode change to DDDR in the AAIR group suggests evolving clinical management strategies post-trial.
Abstract

Keywords:
Dual chamber pacingPacemakerRandomized clinical trialRegister-basedSick sinus syndromeSingle lead atrial pacing

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