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Cardiovascular outcomes with atrial-based pacing compared with ventricular pacing: meta-analysis of randomized trials, using individual patient data.

Publication ,  Journal Article
Healey, JS; Toff, WD; Lamas, GA; Andersen, HR; Thorpe, KE; Ellenbogen, KA; Lee, KL; Skene, AM; Schron, EB; Skehan, JD; Goldman, L; Roberts, RS ...
Published in: Circulation
July 4, 2006

BACKGROUND: Several randomized trials have compared atrial-based (dual-chamber or atrial) pacing with ventricular pacing in patients with bradycardia. No trial has shown a mortality reduction, and only 1 small trial suggested a reduction in stroke. The goal of this review was to determine whether atrial-based pacing prevents major cardiovascular events. METHODS AND RESULTS: A systematic review was performed of publications since 1980. For inclusion, trials had to compare an atrial-based with a ventricular-based pacing mode; use a randomized, controlled, parallel design; and have data on mortality, stroke, heart failure, or atrial fibrillation. Individual patient data were obtained from 5 of the 8 identified studies, representing 95% of patients in the 8 trials, and a total of 35 000 patient-years of follow-up. There was no significant heterogeneity among the results of the individual trials. There was no significant reduction in mortality (hazard ratio [HR], 0.95; 95% confidence interval [CI], 0.87 to 1.03; P=0.19) or heart failure (HR, 0.89; 95% CI, 0.77 to 1.03; P=0.15) with atrial-based pacing. There was a significant reduction in atrial fibrillation (HR, 0.80; 95% CI, 0.72 to 0.89; P=0.00003) and a reduction in stroke that was of borderline significance (HR, 0.81; 95% CI, 0.67 to 0.99; P=0.035). There was no convincing evidence that any patient subgroup received special benefit from atrial-based pacing. CONCLUSIONS: Compared with ventricular pacing, the use of atrial-based pacing does not improve survival or reduce heart failure or cardiovascular death. However, atrial-based pacing reduces the incidence of atrial fibrillation and may modestly reduce stroke.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

July 4, 2006

Volume

114

Issue

1

Start / End Page

11 / 17

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Stroke
  • Randomized Controlled Trials as Topic
  • Humans
  • Heart Ventricles
  • Heart Atria
  • Cardiovascular System & Hematology
  • Cardiac Pacing, Artificial
  • Atrial Fibrillation
  • Arrhythmias, Cardiac
 

Citation

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Chicago
ICMJE
MLA
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Healey, J. S., Toff, W. D., Lamas, G. A., Andersen, H. R., Thorpe, K. E., Ellenbogen, K. A., … Connolly, S. J. (2006). Cardiovascular outcomes with atrial-based pacing compared with ventricular pacing: meta-analysis of randomized trials, using individual patient data. Circulation, 114(1), 11–17. https://doi.org/10.1161/CIRCULATIONAHA.105.610303
Healey, Jeffrey S., William D. Toff, Gervasio A. Lamas, Henning R. Andersen, Kevin E. Thorpe, Kenneth A. Ellenbogen, Kerry L. Lee, et al. “Cardiovascular outcomes with atrial-based pacing compared with ventricular pacing: meta-analysis of randomized trials, using individual patient data.Circulation 114, no. 1 (July 4, 2006): 11–17. https://doi.org/10.1161/CIRCULATIONAHA.105.610303.
Healey JS, Toff WD, Lamas GA, Andersen HR, Thorpe KE, Ellenbogen KA, et al. Cardiovascular outcomes with atrial-based pacing compared with ventricular pacing: meta-analysis of randomized trials, using individual patient data. Circulation. 2006 Jul 4;114(1):11–7.
Healey, Jeffrey S., et al. “Cardiovascular outcomes with atrial-based pacing compared with ventricular pacing: meta-analysis of randomized trials, using individual patient data.Circulation, vol. 114, no. 1, July 2006, pp. 11–17. Pubmed, doi:10.1161/CIRCULATIONAHA.105.610303.
Healey JS, Toff WD, Lamas GA, Andersen HR, Thorpe KE, Ellenbogen KA, Lee KL, Skene AM, Schron EB, Skehan JD, Goldman L, Roberts RS, Camm AJ, Yusuf S, Connolly SJ. Cardiovascular outcomes with atrial-based pacing compared with ventricular pacing: meta-analysis of randomized trials, using individual patient data. Circulation. 2006 Jul 4;114(1):11–17.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

July 4, 2006

Volume

114

Issue

1

Start / End Page

11 / 17

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Stroke
  • Randomized Controlled Trials as Topic
  • Humans
  • Heart Ventricles
  • Heart Atria
  • Cardiovascular System & Hematology
  • Cardiac Pacing, Artificial
  • Atrial Fibrillation
  • Arrhythmias, Cardiac