Single-Chamber versus Dual-Chamber Pacing for High-Grade Atrioventricular Block
William D. Toff, M.D., A. John Camm, M.D., J. Douglas Skehan, M.B., B.S., for the United Kingdom Pacing and Cardiovascular Events (UKPACE) Trial Investigators
Background In the treatment of atrioventricular block, dual-chambercardiac pacing is thought to confer a clinical benefit as comparedwith single-chamber ventricular pacing, but the supporting evidenceis mainly from retrospective studies. Uncertainty persists regardingthe true benefits of dual-chamber pacing, particularly in theelderly, in whom it is used less often than in younger patients.
Methods In a multicenter, randomized, parallel-group trial,2021 patients 70 years of age or older who were undergoing theirfirst pacemaker implant for high-grade atrioventricular blockwere randomly assigned to receive a single-chamber ventricularpacemaker (1009 patients) or a dual-chamber pacemaker (1012patients). In the single-chamber group, patients were randomlyassigned to receive either fixed-rate pacing (504 patients)or rate-adaptive pacing (505 patients). The primary outcomewas death from all causes. Secondary outcomes included atrialfibrillation, heart failure, and a composite of stroke, transientischemic attack, or other thromboembolism.
Results The median follow-up period was 4.6 years for mortalityand 3 years for other cardiovascular events. The mean annualmortality rate was 7.2 percent in the single-chamber group and7.4 percent in the dual-chamber group (hazard ratio, 0.96; 95percent confidence interval, 0.83 to 1.11). We found no significantdifferences between the group with single-chamber pacing andthat with dual-chamber pacing in the rates of atrial fibrillation,heart failure, or a composite of stroke, transient ischemicattack, or other thromboembolism.
Conclusions In elderly patients with high-grade atrioventricularblock, the pacing mode does not influence the rate of deathfrom all causes during the first five years or the incidenceof cardiovascular events during the first three years afterimplantation of a pacemaker.
Source Information
From the Department of Cardiovascular Sciences, University of Leicester (W.D.T.), and the Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital (W.D.T., J.D.S.), Leicester, United Kingdom; and the Division of Cardiac and Vascular Sciences, St George's University of London, London (A.J.C.).
Address reprint requests to Dr. Toff at the Department of Cardiovascular Sciences, University of Leicester, Clinical Sciences Wing, Glenfield Hospital, Groby Rd., Leicester LE3 9QP, United Kingdom, or at w.toff{at}le.ac.uk.
Pacing for Atrioventricular Block
Amato J. L. Jr., Fauchier L., Babuty D., Heist E. K., Harthorne J. W., Singh J. P., Toff W. D., Camm A. J., Skehan J. D., the UKPACE Trial Investigators
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N Engl J Med 2005;
353:1742-1744, Oct 20, 2005.
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