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[Sick sinus syndrome. Pacemaker with atrial versus ventricular stimulation]

H R Andersen1, L Thuesen, J P Bagger

  • 1Hjertemedicinsk afdeling, Skejby Sygehus, Arhus.

Ugeskrift for Laeger
|February 19, 1996
PubMed
Summary

For sick sinus syndrome, atrial pacing significantly reduces atrial fibrillation and thromboembolic events compared to ventricular pacing. This prospective trial supports atrial pacing as the preferred treatment choice.

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Sick sinus syndrome (SSS) is a common indication for cardiac pacing.
  • Previous retrospective studies suggested benefits of atrial pacing over ventricular pacing in SSS patients.

Purpose of the Study:

  • To prospectively compare atrial pacing versus ventricular pacing in patients with sick sinus syndrome.
  • To evaluate the impact of pacing mode on atrial fibrillation, thromboembolism, heart failure, and mortality.

Main Methods:

  • A prospective randomized trial involving 225 consecutive patients with SSS.
  • Patients were randomized to either atrial pacing (n=110) or ventricular pacing (n=115).
  • Follow-up was conducted for up to five years.

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Main Results:

  • Atrial fibrillation occurred more frequently in the ventricular pacing group.
  • Thromboembolic events were significantly lower in the atrial pacing group (6 vs. 20, p=0.008).
  • Mortality (21 vs. 25) and heart failure rates did not differ significantly between groups. Atrioventricular block was rare (2 patients in the atrial group).

Conclusions:

  • Atrial pacing is associated with lower rates of atrial fibrillation and thromboembolic complications in SSS patients.
  • Atrial pacing demonstrates a favorable safety profile with a low risk of atrioventricular block.
  • The findings support the recommendation of atrial pacing over ventricular pacing for patients with sick sinus syndrome.