Relationship Between Pacemaker Dependency and the Effect of Pacing Mode on Cardiovascular Outcomes

Tang, Antony; Roberts, Robin S.; Kerr, Charles R.; Gillis, Anne M.; Green, Martin S.; Talajic, Mario; Yusuf, Salim; Abdollah, Hoshiar; Gent, Michael; Connolly, Stuart J.

doi:10.1161/01.cir.103.25.3081

Cited by 98 publications

(60 citation statements)

References 12 publications

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“…No individual trial showed a significant difference in all-cause or cardiovascular mortality ( In CTOPP, pacemaker dependency was defined as the presence of an underlying spontaneous heart rate of less than 60 bpm. 57 A significant increased risk of death was found in pacemaker-dependent individuals paced with ventricular pacemakers (7.8%) compared with physiological pacing (4.6%), a relative risk reduction of 38% (95% CI 18 to53%, p < 0.001), but an absolute risk reduction of 3.2%, corresponding to a number needed to treat (NNT) of 31. Mortality in non-pacemaker-dependent individuals was not significantly different.…”

Section: Mortalitymentioning

confidence: 99%

“…In CTOPP, pacemaker dependency was indirectly assumed to be present in individuals with underlying spontaneous heart rate lower then 60 bpm during ventricular pacing and measured at baseline. The CTOPP substudy on pacemaker dependency 57 was invalidated by the exclusion of participants for whom end-points had occurred before measurement of underlying spontaneous heart rate. Conclusions from this study should be considered very cautiously.…”

Section: Ancillary Studies and Subgroup Analysesmentioning

confidence: 99%

“…Subgroup analyses were conducted on stroke by pacemaker dependency in CTOPP 57 and by underlying disease (SSS or AVB) in PASE. 35 In CTOPP, no difference was found according to pacemaker dependency, with strokes occurring in 1% of pacemaker-dependent participants on physiological and 0.9% on ventricular pacing.…”

Section: Mortalitymentioning

confidence: 99%

See 2 more Smart Citations

The effectiveness and cost-effectiveness of dual-chamber pacemakers compared with single-chamber pacemakers for bradycardia due to atrioventricular block or sick sinus syndrome: systematic review and economic evaluation

Castelnuovo

Steín²,

Pitt³

et al. 2005

Health Technol Assess

112

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Section: Mortalitymentioning

confidence: 99%

Section: Ancillary Studies and Subgroup Analysesmentioning

confidence: 99%

See 1 more Smart Citation

The effectiveness and cost-effectiveness of dual-chamber pacemakers compared with single-chamber pacemakers for bradycardia due to atrioventricular block or sick sinus syndrome: systematic review and economic evaluation

Castelnuovo

Steín²,

Pitt³

et al. 2005

Health Technol Assess

112

View full text Add to dashboard Cite

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“…31) In spite of lacking the reduction of mortality in physiological pacing, subgroup analysis showed beneficial effect on combined end point of stroke or cardiovascular death, as well as cardiovascular-death and total mortality in pacemaker dependent group but not in non-pacemaker dependent group. 32) In addition, this study reported that unpaced heart rate at first follow-up has an important influence on cardiovascular death and total mortality. Ongoing pacing trial like as the Danish Multicenter Randomized Study (DANPACE) 33) and the United Kingdom Pacing and Clinical Event Trial (UKPace) 34) may provide prospective data on the relation between underlying heart rate and pacing mode selection in view point of mortality.…”

Section: J Arrhythmia Vol 21 No 4 2005mentioning

confidence: 81%

Pacing Therapy for Prevention of Atrial Fibrillation

Mizutani

2005

J Arrhythmia

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Nonpharmacological therapy is being evaluated for the prevention of atrial fibrillation (AF). Pacing has been proposed as a one of the option to prevent AF. In patients with bradycardia and requiring pacemaker, physiological pacing such as dual chamber pacing or atrial pacing has an advantage against ventricular pacing in prevention AF. Pacing from novel site like the dual-site atrium, biatrial, Bachman, and low sepatl pacing may reduce AF burden and new anti-AF pacemakers with atrial prevention algorithm may decrease AF further. However, selecting the appropriate patients and adopting tailored-therapy for individual patient is likely to remain one of the difficulties in achieving an advantage. This review discusses the current status of pacing therapy for the prevention of AF. It also discusses the some of merits and limitations of pacing therapy for the treatment of AF. (J Arrhythmia 2005; 21: 438-449)

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“…This study reported that those with an unpaced heart rate Ͻ60 bpm benefited from physiological pacing, with a significant reduction in the incidence of cardiovascular death or stroke. 3 A small, randomized study of atrial versus ventricular pacing in patients with sinus node dysfunction, the Danish Study, initially reported no benefit of physiological (AAI) pacing at a mean follow-up of 3 years. 4 However, after a more extended follow-up of 5.5 years, significant reductions in death and in atrial fibrillation were reported.…”

mentioning

confidence: 99%

Canadian Trial of Physiological Pacing

Kerr

Connolly²,

Abdollah³

et al. 2004

Circulation

Self Cite

176

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Background— The Canadian Trial of Physiological Pacing (CTOPP) reported that the risk of stroke or cardiovascular death was similar between patients receiving ventricular versus physiological pacemakers at the end of the original follow-up period of 3 years. However, the occurrence of atrial fibrillation was significantly less frequent with physiological pacemakers. To assess a potential delayed benefit of physiological pacing, follow-up of patients in this study was extended to 6 years. Methods and Results— A total of 1474 patients requiring a pacemaker for symptomatic bradycardia were randomized to receive ventricular and 1094 to physiological pacemakers. The primary outcome was stroke or cardiovascular death. The study was completed in July 1998, and follow-up was extended to July 2001. At a mean follow-up of 6.4 years, there was no difference between treatment groups in the primary outcome of cardiovascular death or stroke. There was no significant difference in total mortality or stroke between groups. There was a significantly lower rate of development of atrial fibrillation in the physiological group, with a relative risk reduction of 20.1% (CI, 5.4 to 32.5; P =0.009). Conclusions— The CTOPP extended study does not show a difference in cardiovascular death or stroke, or in total mortality, or in stroke between patients implanted with ventricular or physiological pacemakers over a mean follow-up of >6 years. However, there is a persistent significant reduction in the development of atrial fibrillation with physiological pacing.

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Relationship Between Pacemaker Dependency and the Effect of Pacing Mode on Cardiovascular Outcomes

Cited by 98 publications

References 12 publications

The effectiveness and cost-effectiveness of dual-chamber pacemakers compared with single-chamber pacemakers for bradycardia due to atrioventricular block or sick sinus syndrome: systematic review and economic evaluation

The effectiveness and cost-effectiveness of dual-chamber pacemakers compared with single-chamber pacemakers for bradycardia due to atrioventricular block or sick sinus syndrome: systematic review and economic evaluation

Pacing Therapy for Prevention of Atrial Fibrillation

Canadian Trial of Physiological Pacing

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