High incidence of pacemaker syndrome in patients with sinus node dysfunction treated with ventricular-based pacing in the Mode Selection Trial (MOST)
Key result
Ventricular-based pacing in patients with sinus node dysfunction resulted in an 18.3% incidence of pacemaker syndrome, which improved with reprogramming to dual-chamber pacing.
Why the study?
Pacemaker syndrome causes cardiovascular signs and symptoms induced by VVIR pacing, motivating an evaluation of its incidence, predictors, and treatment in patients with sinus node dysfunction.
Population
996 patients with sinus node dysfunction randomized to VVIR pacing
Design
Substudy of a randomized controlled trial
Follow-up
4 years
Authors
Discussion
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Implication
Pacemaker syndrome incidence with VVIR pacing supports atrial-based preference hypothesis; leaves open confirmation before practice change.
Key Points
- The aim is to evaluate the incidence and predictors of pacemaker syndrome in patients with sinus node dysfunction treated with VVIR pacing.
- Randomized trial involving 996 patients assigned to VVIR pacing.
- Definition of pacemaker syndrome included cardiovascular symptoms or significant blood pressure reduction during pacing.
- Analysis of baseline and post-implantation predictors of pacemaker syndrome.
- 182 patients (18.3%) developed pacemaker syndrome by follow-up.
- Incidence increased from 13.8% at 6 months to 19.7% at 4 years.
- Quality of life improved after reprogramming to dual-chamber pacing.
Study Design
Type
RCT (n=996)
Randomization
randomized
PICO
P
Population
996 patients with sinus node dysfunction randomized to ventricular-based (VVIR) pacing, followed for up to 4 years.
I
Intervention / Comparator
Ventricular-based (VVIR) pacing
O
Primary Outcome
Incidence of pacemaker syndrome
Cite This Study
Link et al. (2004) conducted an RCT in Sinus node dysfunction (n=996). Ventricular-based (VVIR) pacing was evaluated on Incidence of pacemaker syndrome. Ventricular-based pacing in patients with sinus node dysfunction resulted in an 18.3% incidence of pacemaker syndrome, which improved with reprogramming to dual-chamber pacing.