Relation of prognosis in sick sinus syndrome to age, conduction defects and modes of permanent cardiac pacing

Santini, Massimo; Alexidou, Georgia; Ansalone, Gerardo; Cacciatore, Giuseppe; Cini, Roberto; Turitto, Gioia

doi:10.1016/0002-9149(90)91379-k

Cited by 188 publications

(52 citation statements)

References 18 publications

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“…In patients with sinus node disease, maintaining atrioventricular synchrony lowers the risk of atrial fibrillation, heart failure, stroke and mortality during long term follow-up, as demonstrated in both retrospective studies [3,4] and in a randomized prospective study [5] . In high-grade atrioventricular block data are limited, but suggest a survival benefit in patients with heart failure [6,7] .…”

Section: Introductionmentioning

confidence: 92%

Improved cardiac function and quality of life following upgrade to dual chamber pacing after long-term ventricular stimulation

Höijer

Brandt

Willenheimer³

et al. 2002

European Heart Journal

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Aims Many patients with sinus node disease or atrioventricular block have previously received pacemakers with only ventricular stimulation (VVI or VVIR). This study aimed to investigate whether quality of life and cardiac function were affected by an upgrade to dual chamber pacing (DDDR or DDIR) following long-term ventricular stimulation.Methods After implantation of an atrial lead and a DDDR pulse generator, a randomized, double-blind crossover study was performed in 19 patients, previously treated with ventricular pacing for a median time of 6·8 years. Patients were randomized to 8 weeks with either VVIR or DDDR/ DDIR pacing; after this time, the other mode was programmed for 8 weeks. At the end of each period, the patients' quality of life was evaluated and echocardiography was performed together with Holter monitoring and blood samples for brain natriuretic peptide.Results Sixteen of the patients preferred DDDR and two VVIR pacing (P=0·001); one was undecided. Seven patients demanded an early crossover while paced in the VVIR mode, vs none in the DDDR mode (P=0·008). Quality of life was higher in the DDDR mode in 11 of 17 modalities, reaching statistical significance for dyspnoea (P<0·05) and general activity (P<0·05). Echocardiography showed significantly larger left ventricular end-diastolic dimensions in the DDDR mode (P=0·01), whereas end-systolic dimensions did not differ. Left ventricular systolic function was significantly superior in the DDDR mode (mean aortic velocity-time integral: P<0·001) and left atrial diameter was significantly smaller in the DDDR mode (P=0·01). The plasma level of brain natriuretic peptide was significantly lower in DDDR mode (P=0·002).Conclusion An upgrade to dual chamber rate adaptive pacing results in significantly improved quality of life and cardiac function as compared to continued VVIR stimulation and should thus be considered in patients with ventricular pacemakers who have not developed permanent atrial fibrillation or flutter.

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Section: Introductionmentioning

confidence: 92%

Improved cardiac function and quality of life following upgrade to dual chamber pacing after long-term ventricular stimulation

Höijer

Brandt

Willenheimer³

et al. 2002

European Heart Journal

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“…The results of many prospective and retrospective studies have shown significant antiarrhythmic effects. [12][13][14][15][16][17][18][19][20][21] Nonetheless, some patients require relatively faster atrial pacing at a rate of 90 beats/min, which may be poorly tolerated on a long-term basis. [22][23] Basic rate programming does not usually allow atrial pacing percentages higher than 80%.…”

Section: Discussionmentioning

confidence: 99%

Effects of Right Atrial Pacing Preference in Prevention of Paroxysmal Atrial Fibrillation

Ogawa

Ishikawa

Matsushita

et al. 2008

Circ J

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trial fibrillation (AF) occurs as a result of various mechanisms. 1 The initiating mechanisms of AF are considered to be bradycardia, that is, premature atrial contraction (PAC). Pharmacological treatment by class I or III antiarrhythmic drugs is usually effective. 2-3 Nonetheless, some patients are refractory to antiarrhythmic agents. Atrial pacing has been shown to prevent paroxysmal AF. [4][5][6][7] Overdrive atrial pacing is thought to prevent AF triggered by bradycardia and premature atrial beats. The Atrial Pacing Preference™ (APP; Guidant, St Paul, MN, USA) algorithm allows the pacemaker to maintain a pacing rate slightly higher than the sinus rate. However, the efficacy and optimal setting of APP are unclear. The present multicenter study evaluates the efficacy of APP for the prevention of AF and the importance of optimal APP search interval setting in patients with sick sinus syndrome (SSS) and AF. Methods Patient SelectionThe inclusion criteria were those of the American College of Cardiology/American Heart Association class I or II pacemaker indications, together with a history of paroxysmal episodes of AF. Each patient underwent implantation of 2 permanent pacing leads. RA leads were placed at the RA appendage, and RV leads were placed at the RV apex. The exclusion criteria were: presence of chronic AF, <20 years old, pregnancy, undergoing dialysis, chronic renal failure, and severe heart failure. Antiarrhythmic drug therapy remained essentially unchanged in all patients. Written informed consent was obtained from all patients. The local ethics committee approved the study. Device CharacteristicsAll patients received a Model 1280™ (Guidant) combined with bipolar atrial and ventricular pacing leads. The device features included DDDR pacing and DDIR mode switch during atrial tachyarrhythmias and APP algorithm. The APP algorithm allows the pacemaker to maintain a pacing rate slightly higher than the sinus rate. When a Pwave is detected, the next pacing interval is shortened by 8 ms. When the pacing state is maintained for search intervals (ie, 2-128 programmable cycles), the pacing interval is prolonged by 8 ms. The APP pacing rate is limited to the Circ J 2008; 72: 700 -704 (Received July 22, 2007; revised manuscript received November 19, 2007; accepted December 11, 2007 Background Several preliminary studies have indicated that atrial pacing can prevent atrial tachyarrhythmias. The suggested mechanisms by which pacing may be effective include suppression of premature atrial beats. Methods and ResultsThe Atrial Pacing Preference™ (APP; Guidant, St Paul, MN, USA) algorithm allows the pacemaker to maintain a pacing rate slightly higher than the sinus rate. The preventive effects of APP on paroxysmal atrial fibrillation (AF) were studied in 51 patients (70±11 years). Nine patients did not complete the protocol. The pacemaker was programmed in random order to APP off and APP on at 3 different settings (ie, 8, 16 and 32 cycles) for 4 weeks each, using a cross-over design. Percentage atrial pacing was lower...

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“…When a strict limitation of a high Wenckebach block point of more than 140 beats/min and normal QRS morphology was applied to candidates for AAI pacing, no clinically important AV blocks developed. 16 However, Mandel et al reported that 10 of 31 patients developed either pronounced 1st degree or type 1 2nd degree AV block when paced at rates less than 100 beats/min. 17 When Santini et al later also applied this lower Wenckebach block point, they showed some degree of deterioration in about one-fifth of patients.…”

Section: A B Cmentioning

confidence: 99%

“…17 When Santini et al later also applied this lower Wenckebach block point, they showed some degree of deterioration in about one-fifth of patients. 16 No reports of patients with SSS have addressed in detail the relationship between the Wenckebach block point and the histopathological findings of the conduction system. In the present study, 3 of 14 cases showed a Wenckebach block point of 130 beats/min or less with rapid atrial pacing.…”

Section: A B Cmentioning

confidence: 99%

Implications of Marked Fatty Infiltration Around and In the Atrophic Atrioventricular Node in Elderly Patients With Permanent Pacemaker Implantation for Symptomatic Sick Sinus Syndrome

et al. 1999

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Relation of prognosis in sick sinus syndrome to age, conduction defects and modes of permanent cardiac pacing

Cited by 188 publications

References 18 publications

Improved cardiac function and quality of life following upgrade to dual chamber pacing after long-term ventricular stimulation

Improved cardiac function and quality of life following upgrade to dual chamber pacing after long-term ventricular stimulation

Effects of Right Atrial Pacing Preference in Prevention of Paroxysmal Atrial Fibrillation

Implications of Marked Fatty Infiltration Around and In the Atrophic Atrioventricular Node in Elderly Patients With Permanent Pacemaker Implantation for Symptomatic Sick Sinus Syndrome

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