Key result
Minimization of right ventricular pacing algorithms did not significantly reduce persistent AF, cardiovascular hospitalization, or death compared to standard DDDR pacing (RR 1.29; 95% CI 0.43-3.86).
Why the study?
Does the use of algorithms of minimization of right ventricular pacing reduce the composite of persistent AF, cardiovascular hospitalization, and all-cause death in patients with sick sinus syndrome and a history of paroxysmal AF?
RCT (n=74)
No
Does the use of algorithms of minimization of right ventricular pacing reduce the composite of persistent AF, cardiovascular hospitalization, and all-cause death in patients with sick sinus syndrome and a history of paroxysmal AF?
Algorithms to minimize right ventricular pacing did not significantly reduce the composite of persistent AF, cardiovascular hospitalization, or death compared to standard DDDR pacing in patients with sick sinus syndrome and paroxysmal AF.
Answers are grounded in this paper and cite their sources.
No benefit seen with RV pacing minimization in sick sinus syndrome; small RCT leaves efficacy unresolved.
PURPOSE: to assess effectiveness of algorithms of minimization of right ventricular pacing (MRVP) for prevention of progression of atrial fibrillation (AF), lowering of frequency of hospitalizations due to cardiovascular causes, and mortality in patients with sick sinus syndrome (SSS) and history of paroxysmal AF compared with standard compared with dual-chamber pacing (DDDR). MATERIALS AND METHODS: We included in this single-center prospective study 74 consecutive patients with indications to permanent DDDR pacing because of SSS combined with documented history of paroxysmal AF. Patients were randomized in the groups of DDDR pacing (n=36) and with activated algorithms of MRVP (n=38). Pacemaker check up was made after 6 months during 1 year after device implantation. Primary composite endpoint included development of persistent AF, hospitalization due to cardiovascular causes, and all cause death. RESULTS: During follow-up there was no statistically significant difference in achievement of the primary endpoint (27.8 and 18.4% in groups of DDDR pacing and activated algorithms of MRVP respectively (relative risk 1.29% confidence interval 0.43 to 3.86; p=0.25). Rate of development of persistent AF in both groups was comparable (8.6 and 5.3% in DDDR and MRVP groups, respectively; p=0.47). Median AF burden was 6.0 (0;42) and 6.0 (0;42) min/day in DDDR and MRVP groups, respectively (p=0.67). CONCLUSION: Our study failed to demonstrate advantages of the use of algorithms of decreasing "unmotivated" right ventricular pacing over standard regimen of standard DDDR pacing in patients with SSS and history of paroxysmal AF.
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Ivanchina et al. (2018) conducted an RCT in Sick sinus syndrome and history of paroxysmal atrial fibrillation (n=74). Algorithms of minimization of right ventricular pacing (MRVP) vs. Standard dual-chamber pacing (DDDR) was evaluated on Composite of development of persistent AF, hospitalization due to cardiovascular causes, and all cause death (RR 1.29, 95% CI 0.43 to 3.86, p=0.25). Minimization of right ventricular pacing algorithms did not significantly reduce persistent AF, cardiovascular hospitalization, or death compared to standard DDDR pacing (RR 1.29; 95% CI 0.43-3.86).
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