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Adverse effects of first-degree AV-block in patients with sinus node dysfunction: data from the mode selection trial.

Publication ,  Journal Article
Holmqvist, F; Hellkamp, AS; Lee, KL; Lamas, GA; Daubert, JP; MOST investigators,
Published in: Pacing Clin Electrophysiol
September 2014

BACKGROUND: Patients with a pacing indication and first-degree atrioventricular (AV)-block pose a clinical challenge. The prognostic impact of first-degree AV-block in patients with sinus node dysfunction and the impact of pacing in this setting are not known. METHODS: In the Mode Selection Trial (MOST), 2,010 patients with sinus node dysfunction were randomized to either dual-chamber (DDD-R) or ventricular (VVI-R) pacing and followed for a median of 33 months. We report on clinical outcomes in patients with first-degree AV-block (PR interval > 200 ms) compared with patients who had a normal PR interval at baseline. RESULTS: Patients with first-degree AV-block (n = 378) were older (median [Q1, Q3]; 76 [70, 82] years vs 73 [66, 79] years, P< 0.0001), more often male (57% vs 49%, P = 0.0049), and had more comorbidity, such as hypertension (66% vs 60%, P = 0.034) and heart failure (24% vs 17%, P = 0.0050) than patients with normal AV-conduction (n = 1,159). In multivariable analyses, patients with first-degree AV-block were at greater risk of death, stroke, or heart failure hospitalization (hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.06-1.61, P = 0.013). A trend towards a higher incidence of atrial fibrillation was seen (HR 1.24, 95% CI 0.98-1.55, P = 0.069). No significant interactions between pacing arm and prolonged versus normal PR were found for any endpoint, and hazard ratios were consistent across subgroups. CONCLUSIONS: First-degree AV-block is associated with more advanced disease but is still an independent predictor of poor clinical outcome. Neither DDD-R nor VVI-R pacing, as employed in MOST, eliminate the negative effects associated with first-degree AV-block.

Duke Scholars

Published In

Pacing Clin Electrophysiol

DOI

EISSN

1540-8159

Publication Date

September 2014

Volume

37

Issue

9

Start / End Page

1111 / 1119

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Sick Sinus Syndrome
  • Risk Factors
  • Prospective Studies
  • Prognosis
  • Pacemaker, Artificial
  • Male
  • Humans
  • Female
  • Electrocardiography
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Holmqvist, F., Hellkamp, A. S., Lee, K. L., Lamas, G. A., Daubert, J. P., & MOST investigators, . (2014). Adverse effects of first-degree AV-block in patients with sinus node dysfunction: data from the mode selection trial. Pacing Clin Electrophysiol, 37(9), 1111–1119. https://doi.org/10.1111/pace.12404
Holmqvist, Fredrik, Anne S. Hellkamp, Kerry L. Lee, Gervasio A. Lamas, James P. Daubert, and James P. MOST investigators. “Adverse effects of first-degree AV-block in patients with sinus node dysfunction: data from the mode selection trial.Pacing Clin Electrophysiol 37, no. 9 (September 2014): 1111–19. https://doi.org/10.1111/pace.12404.
Holmqvist F, Hellkamp AS, Lee KL, Lamas GA, Daubert JP, MOST investigators. Adverse effects of first-degree AV-block in patients with sinus node dysfunction: data from the mode selection trial. Pacing Clin Electrophysiol. 2014 Sep;37(9):1111–9.
Holmqvist, Fredrik, et al. “Adverse effects of first-degree AV-block in patients with sinus node dysfunction: data from the mode selection trial.Pacing Clin Electrophysiol, vol. 37, no. 9, Sept. 2014, pp. 1111–19. Pubmed, doi:10.1111/pace.12404.
Holmqvist F, Hellkamp AS, Lee KL, Lamas GA, Daubert JP, MOST investigators. Adverse effects of first-degree AV-block in patients with sinus node dysfunction: data from the mode selection trial. Pacing Clin Electrophysiol. 2014 Sep;37(9):1111–1119.

Published In

Pacing Clin Electrophysiol

DOI

EISSN

1540-8159

Publication Date

September 2014

Volume

37

Issue

9

Start / End Page

1111 / 1119

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Sick Sinus Syndrome
  • Risk Factors
  • Prospective Studies
  • Prognosis
  • Pacemaker, Artificial
  • Male
  • Humans
  • Female
  • Electrocardiography