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[The atrial pacemaker as therapy in sinus node disease: retrospective analysis of complications and rate of survival]
B Lemke1, B J Hoeltmann, H Selbach
1Medizinische Klinik und Poliklinik der Berufsgenossenschaftlichen Krankenanstalten Bergmannsheil Bochum.
Insights
Atrial pacing with AAI systems is a safe therapy for bradycardia, with low risks of developing AV-block or atrial fibrillation. Long-term survival rates are comparable to the general population.
Area of Science:
- Cardiology
- Biomedical Engineering
Context:
- Atrial pacing is a common treatment for bradycardia due to sinus node dysfunction.
- Safety concerns regarding atrial pacing persist, necessitating further investigation.
Purpose:
- To evaluate the long-term safety and efficacy of AAI pacing systems.
- To assess the incidence of adverse events such as AV-block, atrial fibrillation, and lead complications.
Summary:
- This retrospective study analyzed 81 patients who received AAI pacing devices between 1972 and 1984.
- The 10-year cumulative incidence of complete AV-block was 5%, and atrial fibrillation was 10%.
- Lead-related complications occurred in 38% of patients after 10 years, influenced by lead tip type and fixation.
Impact:
- AAI pacing is deemed safe for bradycardia treatment when AV-block is absent.
- AAI pacing demonstrates a lower incidence of atrial fibrillation compared to VVI pacing.
- The study suggests a low risk of developing AV-block with AAI pacing systems.
Abstract:
The implantation of an atrial pacing device represents an established mode of therapy for bradycardia in sinus node dysfunction. However, controversial views remain concerning the safety of this type of pacing. To investigate this, we retrospectively analysed data from 81 patients, all of whom received an AAI pacing device between 1972 and 1984. Complete AV-block developed in two out of 81 patients (cumulative incidence after 10 years was 5 +/- 3%). Atrial fibrillation developed in three out of 81 patients (cumulative incidence after 10 years was 10 +/- 5%). Lead-related complications were strongly related to the type of lead tip and the mode of fixation. The overall incidence of lead-related problems was 20 +/- 5% after 5 years and 38 +/- 12% after 10 years. 82 +/- 6% of patients survived the first 5 years, 52 +/- 14% survived for 10 years. The 5 years' survival rate was not different from that of the normal population. From this we conclude that atrial pacing can be safely done with an AAI system as long as there are no signs of an AV-block. Atrial fibrillation develops less often on AAI pacing than on VVI pacing. The risk of developing an AV-block seems rather low.