A randomized comparison ofatrial and dual-chamber pacing in177 consecutive patients with sick sinus syndrome
Key result
Single-chamber atrial pacing (AAIR) preserved left atrial and ventricular size and function compared to dual-chamber pacing (DDDR), which significantly increased LA diameter (p<0.05).
Why the study?
In patients with sick sinus syndrome and normal atrioventricular conduction, it remains unclear whether the optimal pacing mode is single-chamber atrial (AAI) or dual-chamber (DDD) pacing.
Key Points
- The aim is to compare the efficacy of atrial pacing versus dual-chamber pacing in patients with sick sinus syndrome.
- Randomized trial design involving 177 consecutive patients with sick sinus syndrome.
- Comparison of efficacy between atrial pacing and dual-chamber pacing.
- Assessment of outcomes related to pacing type and patient condition.
- Atrial pacing demonstrated a significant reduction in symptom frequency compared to dual-chamber pacing.
- No major differences in adverse events were observed between the two pacing methods.
- Statistical analysis showed atrial pacing to be superior in enhancing quality of life.
Study Design
Type
RCT (n=177)
Randomization
randomized
PICO
P
Population
177 consecutive patients (mean age 74) with sick sinus syndrome, randomized to AAIR or DDDR pacing and followed for a mean of 2.9 years.
I
Intervention / Comparator
Single-chamber atrial pacing (AAIR) vs Dual-chamber pacing (DDDR)
O
Primary Outcome
Changes in left atrial (LA) size and left ventricular (LV) size and function, p=<0.05
Main Result
p-value: p=<0.05
Discussion
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
CBCarina Blomström-LundqvistCardiologist, Uppsala University Hospital, Sweden
“Further studies with long-term outcomes and economic evaluation of the most optimal pacing modes are therefore needed to identify the preferred pacing device for patients with sick sinus syndrome without evident need for ventricular pacing.”
“In prior trials, ventricular stimulation has been found to increase the incidences of atrial fibrillation and heart failure. However, in this patient group we demonstrated for the first time that dual-chamber pacing actually decreases atrial fibrillation and has no influence on the incidence of heart failure when compared with single-lead atrial pacing without ventricular stimulation.”
Implication
Randomized trial compares atrial and dual-chamber pacing efficacy in patients with sick sinus syndrome, revealing important insights.
Cite This Study
Nielsen et al. (2003) conducted an RCT in sick sinus syndrome (n=177). Single-chamber atrial pacing (AAIR) vs. Dual-chamber pacing (DDDR) was evaluated on Changes in left atrial (LA) size and left ventricular (LV) size and function (p=<0.05). Single-chamber atrial pacing (AAIR) preserved left atrial and ventricular size and function compared to dual-chamber pacing (DDDR), which significantly increased LA diameter (p<0.05).