Key result
Atrial pacing linked to an absolute ~25% reduction in chronic AF vs ventricular pacing in SSS.
Why the study?
Although permanent pacemaker implantation for sick sinus syndrome is increasing, atrial pacing remains underused due to concerns that patients may later develop atrioventricular conduction disturbances.
Does atrial pacing prevent transition to chronic atrial fibrillation and preserve hemodynamics compared to ventricular pacing in patients with sick sinus syndrome?
Observational (n=68)
No
Does atrial pacing prevent transition to chronic atrial fibrillation and preserve hemodynamics compared to ventricular pacing in patients with sick sinus syndrome?
Atrial pacing is feasible in the majority of patients with sick sinus syndrome, offering hemodynamic benefits and a lower risk of transition to chronic atrial fibrillation compared to ventricular pacing.
Answers are grounded in this paper and cite their sources.
Atrial pacing may reduce chronic AF progression in sick sinus syndrome; leaves open need for randomized confirmation before practice change.
The Feasibility and Beneficial Effects of Atrial Pacing in Sick Sinus Syndrome The number of patients with sick sinus syndrome (SSS) who have been treated by permanent pacemaker implant has been increasing. But, the percentage of those undergoing atrial pacing is still relatively low because of the fear that these patients could later develop atrioventricular conduction disturbances. The purpose of the present study is to examine the hemodynamic effects of atrial contraction, atrioventricular conductivity and progression to chronic atrial fibrillation , and then to discuss the feasibility and beneficial effects of atrial pacing in SSS. Clinical observations and experimental studies have indicated that, when atrial contraction occurs during ventricular systole, cardiac output and ventricular systolic pressure decrease and atrial pressure increase more than when atrioventricular synchrony is maintained. There was no observed association with second or third degree atrioventricular block in 68 sick sinus patients during follow-up, in spite of some abnormalities in the electrophysiological study. Eleven patients out of 35 (31.4%) who had been paced via the ventricule showed atrial fibrillation, whereas only one out of 15 (6.7%) of those who received atrial pacemakers progressed to atrial fibrillation. These results suggest that SSS is rarely associated with atrioventricular block and that atrial pacing has beneficial effects on hemodynamics and prevention of atrial fibrillation. In conclusion, permanent atrial pacing should be chosen for pacemaker treatment of SSS. Key words : sick sinus syndrome, atrial pacing, atrioventricular conduction, atrial fibrillation, atrial contribution YASUYUKI TANAHASHI, M. D.
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Yasuyuki Tanahashi (1985) conducted an observational in Sick sinus syndrome (n=68). Atrial pacing vs. Ventricular pacing was evaluated on Progression to chronic atrial fibrillation. Atrial pacing was associated with a lower progression to chronic atrial fibrillation (6.7% vs 31.4% with ventricular pacing) and zero cases of second- or higher-degree AV block in sick sinus syndrome.
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