Key result
Baseline Wenckebach block rate ≥130 bpm is linked to lower ventricular lead addition in AAI pacing.
Why the study?
In patients with sick sinus syndrome, prior studies of single atrial lead (AAI) pacing were limited by short follow-up and prophylactic ventricular lead use, leaving the long-term natural history of atrioventricular conduction and the prognostic value of baseline Wenckebach block rate uncertain.
Does a baseline Wenckebach block rate ≥130 bpm reduce the incidence of ventricular lead addition for bradyarrhythmia in symptomatic sick sinus syndrome patients receiving single atrial lead pacing?
Cohort (n=142)
Does a baseline Wenckebach block rate ≥130 bpm reduce the incidence of ventricular lead addition for bradyarrhythmia in symptomatic sick sinus syndrome patients receiving single atrial lead pacing?
In symptomatic sick sinus syndrome patients with preserved atrioventricular conduction receiving AAI pacing, ventricular lead addition is rarely needed over long-term follow-up, and a baseline Wenckebach block rate ≥130 bpm effectively stratifies patients at lower risk.
Answers are grounded in this paper and cite their sources.
Supports WBR-guided risk stratification for AAI pacing in sick sinus syndrome; extends long-term observational data but leaves open prospective validation.
Background/Introduction In patients with sick sinus syndrome (SSS), concerns about long-term atrioventricular (AV) conduction stability have led to frequent dual-chamber implantation. Although single atrial lead pacing (AAI pacing) is considered safe, prior studies were limited by short follow-up and prophylactic ventricular lead use, leaving long-term natural history uncertain. Contemporary pacing strategies emphasize avoiding unnecessary ventricular pacing and lead-related complications, underscoring the importance of clarifying the long-term need for ventricular lead addition. Purpose We sought to define the long-term natural history of AV conduction after AAI pacing and evaluate the prognostic value of baseline Wenckebach block rate (WBR). Methods We retrospectively analyzed 142 consecutive symptomatic SSS patients who underwent electrophysiological study and received AAI pacing between 1991 and 2010. Patients with preserved AV conduction and baseline WBR ≥100 bpm were stratified by a pre-specified 130 bpm cut-off. The primary endpoint was ventricular lead addition for bradyarrhythmia. Results Median follow-up was 206 months (IQR 114–246), and 97 patients (68%) were followed until death. Ventricular lead addition occurred in 10 patients (0.45 per 100 person-years). Kaplan–Meier analysis showed a lower incidence in patients with WBR ≥130 bpm than in those with WBR <130 bpm (log-rank p=0.002). Baseline WBR predicted ventricular lead addition and provided clinically useful risk stratification (AUC 0.78). Conclusions Over extended follow-up, ventricular lead addition was rarely required after AAI pacing in SSS patients with preserved AV conduction. Baseline WBR enables long-term risk stratification and may help guide pacing strategy.
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Takami et al. (2026) conducted a cohort in Sick sinus syndrome (n=142). Baseline Wenckebach block rate >=130 bpm in single atrial lead (AAI) pacing vs. Baseline Wenckebach block rate <130 bpm in single atrial lead (AAI) pacing was evaluated on Ventricular lead addition for bradyarrhythmia (p=0.002). In AAI pacing for sick sinus syndrome, baseline Wenckebach block rate >=130 bpm had lower ventricular lead addition than <130 bpm (p=0.002; overall 0.45 per 100 person-years; AUC 0.78).
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