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Cardiac pacing strategies and post-implantation risk of atrial fibrillation and heart failure events in sinus node dysfunction patients: a collaborative analysis of over 6000 patients.

Publication ,  Journal Article
Chen, S; Wang, Z; Kiuchi, MG; Andrea, BR; Krucoff, MW; Liu, S; Pürerfellner, H
Published in: Clin Res Cardiol
August 2016

BACKGROUND: Pacing-modes selection in sinus-node-dysfunction (SND) patients continues to be a subject of debate. Atrial fibrillation (AF) and cardiac dysfunction remain significant problems following cardiac-pacing therapy. Prevention of these complications is of clinical relevance. METHODS: We performed a collaborative pooled-analysis of randomized trials (RCT) to evaluate the effect of currently available pacing strategies on the risk of post-implantation AF and heart failure events (HF) in SND patients. The primary endpoint was a composite AF and HF events. RESULTS: Ten RCTs (n = 6639, male 57 %, median follow-up 2.5 years) were included. The pooled-analysis was stratified into two subsets [single chamber atrial pacing (AAI) vs. dual chamber pacing (DDD), and minimal ventricular pacing (MinVP) vs. DDD]. No significant difference was observed in the AAI vs. DDD subset regarding the primary outcome (P = 0.83). Notably, the mean percentage of ventricular-pacing in the MinVP group was 6.5 vs. 77.4 % in the DDD group (P < 0.05), and MinVP was associated with a substantially reduced risk of composite AF and HF (OR 0.66, P = 0.007) in patients receiving pacemaker as primary treatment. However, in the long-term paced patients scheduled for device replacement, there was no significant difference in the rate of primary endpoint between MinVP vs. DDD groups (P > 0.05). CONCLUSIONS: These results support MinVP over conventional DDD for SND patients who received pacemaker as primary treatment in improving the clinical outcome. For patients who already had chronic ventricular-pacing and impaired cardiac function, a device update to MinVP algorithm may exert no favorable effect on the cardiac performance.

Duke Scholars

Published In

Clin Res Cardiol

DOI

EISSN

1861-0692

Publication Date

August 2016

Volume

105

Issue

8

Start / End Page

687 / 698

Location

Germany

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Sick Sinus Syndrome
  • Risk Factors
  • Risk Assessment
  • Randomized Controlled Trials as Topic
  • Pacemaker, Artificial
  • Odds Ratio
  • Male
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
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Chen, S., Wang, Z., Kiuchi, M. G., Andrea, B. R., Krucoff, M. W., Liu, S., & Pürerfellner, H. (2016). Cardiac pacing strategies and post-implantation risk of atrial fibrillation and heart failure events in sinus node dysfunction patients: a collaborative analysis of over 6000 patients. Clin Res Cardiol, 105(8), 687–698. https://doi.org/10.1007/s00392-016-0973-1
Chen, Shaojie, Zhenglong Wang, Marcio Galindo Kiuchi, Bruno Rustum Andrea, Mitchell W. Krucoff, Shaowen Liu, and Helmut Pürerfellner. “Cardiac pacing strategies and post-implantation risk of atrial fibrillation and heart failure events in sinus node dysfunction patients: a collaborative analysis of over 6000 patients.Clin Res Cardiol 105, no. 8 (August 2016): 687–98. https://doi.org/10.1007/s00392-016-0973-1.
Chen, Shaojie, et al. “Cardiac pacing strategies and post-implantation risk of atrial fibrillation and heart failure events in sinus node dysfunction patients: a collaborative analysis of over 6000 patients.Clin Res Cardiol, vol. 105, no. 8, Aug. 2016, pp. 687–98. Pubmed, doi:10.1007/s00392-016-0973-1.
Journal cover image

Published In

Clin Res Cardiol

DOI

EISSN

1861-0692

Publication Date

August 2016

Volume

105

Issue

8

Start / End Page

687 / 698

Location

Germany

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Sick Sinus Syndrome
  • Risk Factors
  • Risk Assessment
  • Randomized Controlled Trials as Topic
  • Pacemaker, Artificial
  • Odds Ratio
  • Male
  • Humans