Ventricular pacing or dual-chamber pacing for sinus-node dysfunction

Authors

Gervasio A. Lamas , M.D., Mount Sinai Medical Center, University of Miami
Kerry L. Lee ,Ph. D., Duke Clinical Research Institute, Duke University School of Medicine
Michael O. Sweeney , M.D., Brigham and Women's Hospital, Harvard Medical School
Russell Silverman , M.D., Heart Care Center
Angel Leon , M.D., Emory University, Crawford Long Hospital
Raymond Yee , M.D., University Hospital, Ont., Canada
Roger A. Marinchak , M.D., Lankenau Hospital
Greg Flaker , M.D., University of Missouri Hospital and Clinics
Eleanor Schron , M.S., R.N., National Heart, Lung, and Blood Institute
E. John Orav , Ph.D., Brigham and Women's Hospital, Harvard Medical School
Anne S. Hellkamp, Duke Clinical Research Institute, Duke University School of Medicine
Lee Goldman , M.D., University of California - San Francisco
Stephen Greer , M.D., Baptist Medical Center
John McAnulty , M.D., Oregon Health Sciences University
Kenneth Ellenbogen , M.D., Virginia Commonwealth UniversityFollow
Frederick Ehlert , M.D., St. Luke's-Roosevelt Medical Center
Roger A. Freedman , M.D., University of Utah Health Sciences Center
N.A. Mark Estes III, M.D., New England Medical Center
Arnold Greenspon , M.D., Thomas Jefferson University Hospital

Document Type

Article

Original Publication Date

2002

Journal/Book/Conference Title

The New England Journal of Medicine

Volume

346

Issue

24

First Page

1854

Last Page

1862

DOI of Original Publication

10.1056/NEJMoa013040

Comments

Originally published at http://dx.doi.org/10.1056/NEJMoa013040

Date of Submission

January 2015

Abstract

BACKGROUND

Dual-chamber (atrioventricular) and single-chamber (ventricular) pacing are alternative treatment approaches for sinus-node dysfunction that causes clinically significant bradycardia. However, it is unknown which type of pacing results in the better outcome.

METHODS

We randomly assigned a total of 2010 patients with sinus-node dysfunction to dual-chamber pacing (1014 patients) or ventricular pacing (996 patients) and followed them for a median of 33.1 months. The primary end point was death from any cause or nonfatal stroke. Secondary end points included the composite of death, stroke, or hospitalization for heart failure; atrial fibrillation; heart-failure score; the pacemaker syndrome; and the quality of life.

RESULTS

The incidence of the primary end point did not differ significantly between the dual-chamber group (21.5 percent) and the ventricular-paced group (23.0 percent, P=0.48). In patients assigned to dual-chamber pacing, the risk of atrial fibrillation was lower (hazard ratio, 0.79; 95 percent confidence interval, 0.66 to 0.94; P=0.008), and heart-failure scores were better (P

CONCLUSIONS

In sinus-node dysfunction, dual-chamber pacing does not improve stroke-free survival, as compared with ventricular pacing. However, dual-chamber pacing reduces the risk of atrial fibrillation, reduces signs and symptoms of heart failure, and slightly improves the quality of life. Overall, dual-chamber pacing offers significant improvement as compared with ventricular pacing.

Rights

From The New England Journal of Medicine, Lamas, G.A., Lee, K.L., Sweeney, M.O., et al., Ventricular pacing or dual-chamber pacing for sinus-node dysfunction, Vol. 346, Page 1854, Copyright © 2002 Massachusetts Medical Society. Reprinted with permission.

Is Part Of

VCU Internal Medicine Publications