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Previous Volume 357:1000-1008 September 6, 2007 Number 10 Next

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ABSTRACT

Background Conventional dual-chamber pacing maintains atrioventricular synchrony but results in high percentages of ventricular pacing, which causes ventricular desynchronization and has been linked to an increased risk of atrial fibrillation in patients with sinus-node disease.

Methods We randomly assigned 1065 patients with sinus-node disease, intact atrioventricular conduction, and a normal QRS interval to receive conventional dual-chamber pacing (535 patients) or dual-chamber minimal ventricular pacing with the use of new pacemaker features designed to promote atrioventricular conduction, preserve ventricular conduction, and prevent ventricular desynchronization (530 patients). The primary end point was time to persistent atrial fibrillation.

Results The mean (±SD) follow-up period was 1.7±1.0 years when the trial was stopped because it had met the primary end point. The median percentage of ventricular beats that were paced was lower in dual-chamber minimal ventricular pacing than in conventional dual-chamber pacing (9.1% vs. 99.0%, P<0.001), whereas the percentage of atrial beats that were paced was similar in the two groups (71.4% vs. 70.4%, P=0.96). Persistent atrial fibrillation developed in 110 patients, 68 (12.7%) in the group assigned to conventional dual-chamber pacing and 42 (7.9%) in the group assigned to dual-chamber minimal ventricular pacing. The hazard ratio for development of persistent atrial fibrillation in patients with dual-chamber minimal ventricular pacing as compared with those with conventional dual-chamber pacing was 0.60 (95% confidence interval, 0.41 to 0.88; P=0.009), indicating a 40% reduction in relative risk. The absolute reduction in risk was 4.8%. The mortality rate was similar in the two groups (4.9% in the group receiving dual-chamber minimal ventricular pacing vs. 5.4% in the group receiving conventional dual-chamber pacing, P=0.54).

Conclusions Dual-chamber minimal ventricular pacing, as compared with conventional dual-chamber pacing, prevents ventricular desynchronization and moderately reduces the risk of persistent atrial fibrillation in patients with sinus-node disease. (ClinicalTrials.gov number, NCT00284830 [ClinicalTrials.gov] .)

Source Information

From Brigham and Women's Hospital, Boston (M.O.S.); St. Paul Heart Clinic, St. Paul, MN (A.J.B.); Peninsula Cardiology Associates, Salisbury, MD (E.N.); Medtronic, Minneapolis (M.K., Q.C.Z., D.H., T.S.); and Mt. Sinai Medical Center, Miami Beach, FL (G.A.L.).

Address reprint requests to Dr. Sweeney at the Cardiac Arrhythmia Service, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, or at mosweeney{at}partners.org.

Full Text of this Article

Related Letters:

Minimizing Ventricular Pacing in Sinus-Node Disease
Wang N. C., Passman R., Goldberger J. J., Sweeney M. O., Lamas G. A.
Extract | Full Text | PDF  
N Engl J Med 2007; 357:2733-2734, Dec 27, 2007. Correspondence

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