Yonsei Med J.  2010 Nov;51(6):832-837. 10.3349/ymj.2010.51.6.832.

Long-Term Outcome of Single-Chamber Atrial Pacing Compared with Dual-Chamber Pacing in Patients with Sinus-Node Dysfunction and Intact Atrioventricular Node Conduction

• Kim WH
• Joung B
• Shim J
• Park JS
• Hwang ES
• Pak HN
• Kim S
• Lee M

• KMID: 1779627
• DOI: http://doi.org/10.3349/ymj.2010.51.6.832

Abstract

PURPOSE
The optimal pacing mode with either single chamber atrial pacemaker (AAI or AAIR) or dual chamber pacemaker (DDD or DDDR) is still not clear in sinus-node dysfunction (SND) and intact atrioventricular (AV) conduction.
MATERIALS AND METHODS
Patients who were implanted with permanent pacemaker using AAI(R) (n = 73) or DDD(R) (n = 113) were compared.
RESULTS
The baseline characteristics were comparable between the two groups, with a mean follow-up duration of 69 months. The incidence of death did not show statistical difference. However, the incidence of hospitalization for congestive heart failure (CHF) was significantly lower in the AAI(R) group (0%) than the DDD(R) group (8.8%, p = 0.03). Also, atrial fibrillation (AF) was found in 2.8% in the AAI(R) group, which was statistically different from 15.2% of patients in the DDD(R) group (p = 0.01). Four patients (5.5%) with AAI(R) developed AV block, and subsequently switched to DDD(R) pacing. The risk of AF was lower in the patients implanted with AAI(R) than those with DDD(R) [hazard ratio (HR), 0.84; 95% confidence interval, 0.72 to 0.97, p = 0.02].
CONCLUSION
In patients with SND and intact AV conduction, AAI(R) pacing can achieve a better clinical outcome in terms of occurrence of CHF and AF than DDD(R) pacing. These findings support AAI(R) pacing as the preferred pacing mode in patients with SND and intact AV conduction.

Keyword

Sinus node dysfunction; intact AV conduction

MeSH Terms

Aged
Atrial Fibrillation/complications/physiopathology
Atrioventricular Node/*physiopathology
Cardiac Pacing, Artificial
Cohort Studies
Female
Follow-Up Studies
Heart Failure/complications
Humans
Male
Middle Aged
Proportional Hazards Models
Retrospective Studies
Sick Sinus Syndrome/*physiopathology
Treatment Outcome

Figure

• 

  Fig. 1 Kaplan-Meier event-free survival from total death, primary end point. The cumulative incidence of total death was not significant in both groups (p = 0.25 by log-rank test). There was no significant difference, but a higher incidence of events in the DDD(R) group than in the AAI(R) group.

• 

  Fig. 2 Kaplan-Meier event-free survival from hospitalization for CHF. The cumulative incidence of hospitalization for CHF was significantly lower in the AAI(R) group than the DDD(R) group (p = 0.02 by log-rank test). CHF, congestive heart failure.

• 

  Fig. 3 Kaplan-Meier event-free survival from hospitalization for AF. The curve was significantly better in the AAI(R) group than in the DDD(R) group (p = 0.01 by log-rank test). AF, atrial fibrillation.

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