Cardiovascular Outcomes With Atrial-Based Pacing Compared With Ventricular Pacing

Abstract

Background-Several randomized trials have compared atrial-based (dual-chamber or atrial) pacing with ventricular pacing in patients with bradycardia. No trial has shown a mortality reduction, and only 1 small trial suggested a reduction in stroke. The goal of this review was to determine whether atrial-based pacing prevents major cardiovascular events. Methods and Results-A systematic review was performed of publications since 1980. For inclusion, trials had to compare an atrial-based with a ventricular-based pacing mode; use a randomized, controlled, parallel design; and have data on mortality, stroke, heart failure, or atrial fibrillation. Individual patient data were obtained from 5 of the 8 identified studies, representing 95% of patients in the 8 trials, and a total of 35 000 patient-years of follow-up. There was no significant heterogeneity among the results of the individual trials.

2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing

“…The evidence is stronger for patients with sinus node disease, in whom dual-chamber pacing confers a modest reduction in AF and stroke, but not in hospitalization for HF or death compared with ventricular pacing. In patients with acquired atrioventricular block, large randomized parallel trials were unable to demonstrate the superiority of dual-chamber pacing over ventricular pacing with regard to hard clinical endpoints of mortality and morbidity [4,[6][7][8]. The benefit of dualchamber over ventricular pacing is primarily due to the avoidance of pacemaker syndrome and to improved exercise capacity [14].…”

“…The results of a number of large-scale, prospective randomized trials demonstrated a significant reduction in AF in pacemaker patients with atrial-based pacing (AAI or DDD) compared with patients with ventricular-based pacing [4,8,29]. In the Mode Selection Trial, which enrolled 2010 patients with sick sinus syndrome, the risk of AF increased linearly with the increasing percentage of RV pacing [30].…”

“…It is of note that most information on pacing modes has been collected from pacemaker patients, and these patients are clinically distinct from ICD recipients. Dual-chamber pacing (atrial and ventricular) has been compared with single-chamber pacing (atrial or ventricular) in patients with bradycardia in 5 multicenter, parallel, randomized trials, in 1 meta-analysis of randomized trials, and in 1 systematic review that also included 30 randomized crossover comparisons and 4 economic analyses [3][4][5][6][7][8][9]. Meta analyses comparing dual-chamber to single-chamber ICDs did not evaluate pacing modes [10,11].…”

Current possibilities of permanent pacing for prevention of atrial fibrillation and heart failure progression

“…С другой стороны, не у всех пациентов, подвергающихся длитель-ной правожелудочковой стимуляции, выявлено увеличе-ние смертности или развитие ХСН [8].…”

2013 ESC Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy

“…Enfermedad del nodo sinusal (recomendaciones [1][2][3] En general, la BS es una indicación para la estimulación cardiaca solo si la bradicardia es sintomática. Los síntomas podrían estar presentes en reposo, pero con más frecuencia aparecen durante el ejercicio.…”