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July 8, 2014Kardiologia PolskaOpen Access

Effectiveness of atrial versus atrioventricular pacing for sick sinus syndrome during long-term follow-up

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Key result

Atrial pacing (AAI) was associated with a significantly higher rate of reoperation compared to atrioventricular (DDD) pacing (26.7% vs 8.57%, p < 0.01) during long-term follow-up in patients with sick sinus syndrome.

Why the study?

Does atrial pacing (AAI) compared to atrioventricular pacing (DDD) improve clinical outcomes in patients with sick sinus syndrome?

Population

809 patients with sick sinus syndrome who underwent pacemaker implantation, including 86 in the AAI group…

Comparison

Atrial pacing (AAI) vs Atrioventricular pacing (DDD)

Design

Cohort

Follow-up

52 ± 25 months

Authors

MKMarcin KuniewiczJagiellonian UniversityARAnna RydlewskaJohn Paul II HospitalGKGrzegorz KarkowskiJagiellonian University

Discussion

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Member takes

Implication

AAI associated with higher reoperation than DDD in SSS; leaves open optimal mode selection pending randomized data.

Study Design

Type

Cohort (n=809)

Multicenter

No

Structured PICO

Does atrial pacing (AAI) compared to atrioventricular pacing (DDD) improve clinical outcomes in patients with sick sinus syndrome?

P
Population
809 patients with sick sinus syndrome who underwent pacemaker implantation, followed for a mean of 52 months.
E
Exposure
Atrial pacing (AAI)
C
Comparator
Atrioventricular pacing (DDD)
O
Outcome
Clinical outcomes including survival, development of atrial fibrillation, need for reoperation, and lead-related complicationshard clinical

Main Result

Absolute Event Rate: 26.7% vs 8.57%

p-value: p=<0.01

In patients with sick sinus syndrome, AAI and DDD pacing offer similar survival and AF rates, but AAI is associated with a significantly higher risk of reoperation, supporting the guideline preference for DDD pacing.

Limitations

  • Nonrandomised, retrospective, single-centre observation
  • Relatively low number of patients with atrial pacing
  • Potential selection bias due to the requirement for complete procedural and long-term follow-up records
  • Unable to evaluate the percentage of ventricular pacing in the DDD group due to the retrospective nature of the study

Cite This Study

Kuniewicz et al. (2014) conducted a cohort in Sick sinus syndrome (SSS) (n=809). Atrial pacing (AAI) vs. Atrioventricular pacing (DDD) was evaluated on Reoperation (p=<0.01). Atrial pacing (AAI) was associated with a significantly higher rate of reoperation compared to atrioventricular (DDD) pacing (26.7% vs 8.57%, p < 0.01) during long-term follow-up in patients with sick sinus syndrome.

synapsesocial.com/papers/6a96755517cb0e8b160e2054https://doi.org/10.5603/kp.a2014.0148
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1AV Block and Changes in Pacing Mode During Long‐Term Follow‐Up of 399 Consecutive Patients with Sick Sinus Syndrome Treated with an AAI/AAIR Pacemaker2001 · 91 citations
  2. 2Long‐Term Survival of Chosen Atrial‐Based Pacing Modalities1996 · 8 citations
  3. 3Long‐Term Performance of Endocardial Pacing Leads1994 · 64 citations
  4. 4Incidence and predictors of in-hospital events after first implantation of pacemakers2007 · 69 citations
  5. 5Device‐Related Infection Among Patients With Pacemakers and Implantable Defibrillators: Incidence, Risk Factors, and Consequences2010 · 188 citations