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Previous Volume 346:1854-1862 June 13, 2002 Number 24 Next

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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<0.001). The differences in the rates of hospitalization for heart failure and of death, stroke, or hospitalization for heart failure were not significant in unadjusted analyses but became marginally significant in adjusted analyses. Dual-chamber pacing resulted in a small but measurable increase in the quality of life, as compared with ventricular pacing.

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.

Source Information

From the Division of Cardiology, Mount Sinai Medical Center, and the University of Miami School of Medicine, Miami Beach, Fla. (G.A.L.); the Duke Clinical Research Institute and Duke University School of Medicine, Durham, N.C. (K.L.L., A.S.H.); Brigham and Women's Hospital and Harvard Medical School, Boston (M.O.S., E.J.O.); Heart Care Center, Fayetteville, N.Y. (R.S.); Emory University and Crawford Long Hospital, Atlanta (A.L.); University Hospital, London, Ont., Canada (R.Y.); Lankenau Hospital, Wynnewood, Pa. (R.A.M.); University of Missouri Hospital and Clinics, Columbia (G.F.); the Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md. (E.S.); and the Department of Medicine, University of California at San Francisco, San Francisco (L.G.).

Other authors were Stephen Greer, M.D. (Baptist Medical Center, Little Rock, Ark.), John McAnulty, M.D. (Oregon Health Sciences University, Portland), Kenneth Ellenbogen, M.D. (Medical College of Virginia, Richmond), Frederick Ehlert, M.D. (St. Luke's–Roosevelt Medical Center, New York), Roger A. Freedman, M.D. (University of Utah Health Sciences Center, Salt Lake City), N.A. Mark Estes III, M.D. (New England Medical Center, Boston), and Arnold Greenspon, M.D. (Thomas Jefferson University Hospital, Philadelphia).

Address reprint requests to Dr. Lamas at Cardiovascular Associates of Miami, 4300 Alton Rd., Suite 207, Miami Beach, FL 33140, or at glamas{at}msmc.com.

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Cardiac Pacing for Sinus-Node Dysfunction
Blackman B. T., Lamas G. A., Lee K. L., Goldman L.
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N Engl J Med 2002; 347:1891-1892, Dec 5, 2002. Correspondence

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