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

2016 ◽  
Vol 105 (8) ◽  
pp. 687-698 ◽  
Author(s):  
Shaojie Chen ◽  
Zhenglong Wang ◽  
Marcio Galindo Kiuchi ◽  
Bruno Rustum Andrea ◽  
Mitchell W. Krucoff ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Sinus Node ◽  
Cardiac Pacing ◽  
Sinus Node Dysfunction ◽  
Pacing Strategies ◽  
Collaborative Analysis ◽  
Post Implantation

Clinical outcomes with ventricular pacing or dual-chamber pacing for sinus-node dysfunction: a nationwide matched control study

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
L Fauchier ◽  
A Bodin ◽  
A Bisson ◽  
J Herbert ◽  
V Ah-Fat ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Clinical Outcomes ◽  
Sinus Node ◽  
Cardiovascular Death ◽  
Sinus Node Dysfunction ◽  
Dual Chamber ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Funding Acknowledgements Type of funding sources: None. Introduction.Evidence from randomized trials suggests that, in patients with sinus-node dysfunction (SND), physiologic pacing (dual-chamber, DDD) may be superior to single-chamber (ventricular, VVI) pacing because it is associated with lower risks of atrial fibrillation and stroke, better exercise capacity and lower risk of pacemaker syndrome. However, benefits on mortality and risk of heart failure have not been demonstrated and these issues have not been fully evaluated in large "real life" analyses. Objective.The aim of our study was to assess and compare clinical outcomes within the first 30 days and during a longer-term follow-up with the two types of pacing at a nationwide level for patients with SND. Methods and results.Using the administrative hospital database in France 2010-2020, 52,974 patients with SND were included in the analysis: 4,069 patients had VVI pacing and 48,905 had DDD pacing. Patients with leadless VVI pacemakers were excluded of the analysis. After propensity score matching 2,213 patients with VVI pacemaker were matched 1:1 with 2,213 patients treated with DDD pacemaker. In the matched analysis, patients with DDD pacemakers had a lower rate of all-cause (hazard ratio HR 0.711, 95%CI 0.61-0.828) and cardiovascular death (HR 0.628, 95%CI 0.48-0.818) within the 30 days after implantation. There were no significant differences for incidence of tamponade (HR 0.666, 95%CI 0.11-3.992), pneumothorax (HR 1.000, 95%CI 0.32-3.105), hemothorax (HR 0.800, 95%CI 0.21-2.982), major bleeding (HR 0.824, 95%CI 0.68-1.005) and transfusion (HR 1.016, 95%CI 0.83-1.243). During subsequent follow-up (mean: 3.0 ± 2.8 years), risk of all-cause death in the matched population was significantly lower in the DDD group than in the VVI pacemaker group (HR 0.683, 95%CI 0.60-0.784). Patients with SND treated DDD pacemakers also had a lower risk of cardiovascular death (HR 0.569, 95%CI 0.44-0.732), new-onset atrial fibrillation (HR 0.638, 95%CI 0.58-0.706), ischemic stroke (HR 0.685, 95%CI 0.53-0.887) and hospitalization for heart failure (HR 0.758, 95%CI 0.68-0.850) than those treated VVI pacemakers, whilst risk of endocarditis was not significantly different (HR 0.986, 95%CI 0.50-1.951).  Conclusion.Patients with SND treated with DDD pacemakers had better clinical outcomes compared to those treated with VVI pacemakers. DDD pacing was associated with lower risks of death, cardiovascular death, new-onset atrial fibrillation, ischemic stroke, hospitalization for heart failure. DDD pacing was neither associated with a higher risk of complication on the short-term nor of endocarditis on the longer-term.

Atrial tachyarrhythmias in bradycardia–tachycardia syndrome: characterization and evolution

ESC CardioMed ◽  
2018 ◽  
pp. 1954-1957
Author(s):  
Luigi Padeletti ◽  
Roberto De Ponti
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Flutter ◽  
Sinus Node ◽  
Ventricular Myocardium ◽  
Sinus Node Dysfunction ◽  
Ventricular Pacing ◽  
Atrial Tachyarrhythmia ◽  
Atrial Tachyarrhythmias ◽  
Node Disease ◽  
Sinus Node Disease

The association of sinus node disease and atrial tachyarrhythmias characterizes the bradycardia–tachycardia syndrome, which may result in an increased risk of heart failure, stroke, and death. Ageing and several cardiac and extracardiac diseases, which have the potential to affect both the atrial and the ventricular myocardium, can manifest their influence predominantly on the atria, leading to an atrial cardiomyopathy. In these cases, the same pathological process which leads to sinus node dysfunction can create a favourable substrate also for atrial tachyarrhythmias, which, if not present at the time of the initial diagnosis of the sinus node disease, can occur with an increasing prevalence during follow-up. In younger patients with no evident structural heart disease, a bradycardia–tachycardia syndrome may be the first clinical and unexpected manifestation of a still undiagnosed inherited genetic disease and therefore a specific diagnostic workup is necessary. In bradycardia–tachycardia syndrome, the most frequently encountered atrial tachyarrhythmia is atrial fibrillation, while typical atrial flutter is rarer. In peculiar subgroups of patients, other atrial tachyarrhythmias, such as atypical atrial flutter, macroreentrant or focal atrial tachycardia, may be present. In bradycardia–tachycardia syndrome, the evolution of atrial tachyarrhythmias clearly shows a worsening with an prevalence of associated atrial tachyarrhythmia over time. Pharmacological therapy for arrhythmias is of limited use, due to the concomitant sinus node dysfunction. The modality of pacing used to manage the sinus node disease has to be carefully chosen to minimize the evolution of atrial tachyarrhythmias. In fact, while ventricular pacing increases the incidence of atrial fibrillation and stroke, dual-chamber pacing with a specific algorithm for ventricular pacing minimization and prevention and treatment of atrial tachyarrhythmias reduces a composite endpoint of evolution to permanent atrial fibrillation, hospitalization, and death.

P1259Right atrial low voltage zone as a novel predictor of sinus node dysfunction in patients with non-paroxysmal atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Kondo ◽  
M Kimura ◽  
M Nakayama ◽  
O Matsuda
Keyword(s):  
Atrial Fibrillation ◽  
Low Voltage ◽  
Sinus Node ◽  
Pacemaker Implantation ◽  
Left Ventricular ◽  
Sinus Node Dysfunction ◽  
Right Atrial ◽  
Left Ventricular Ejection ◽  
Ablation Procedure ◽  
Ventricular Ejection Fraction

Abstract Background Although sinus node dysfunction (SND) coexists with atrial fibrillation (AF) in some cases, SND in patients with Non-paroxysmal AF (Non-PAF) could not be estimated in conventional electrophysiological study. Atrial low voltage zone (LVZ), which may be surrogate for atrial fibrosis, is although reported to present in patients with Non-PAF, the association between SND and right atrial LVZ (RA-LVZ) has not been fully evaluated. The aim of the present study was to assess the relationship between SND and RA-LVZ in patients with Non-PAF. Method Eighty-six Non-PAF patients underwent high density voltage mapping of right atrium (RA) during AF before ablation procedure. We defined LVZ as that with electrogram amplitude <0.1 mV in order to delineate strongly damaged area in RA. We evaluated the surface are of the RA-LVZ in Non-PAF patients with and without SND. Results Twenty-seven of 86 patients (31.4%) presented with SND after AF termination. There were no significant differences between patients with and without SND in variables such as age, sex, AF duration, left atrial diameter, and left ventricular ejection fraction. The mean value of RA-LVZ of all the patients was 12.1±11.4%, and RA-LVZ was significantly larger in patients with SND than in those without SND (22.8±14.6 vs 7.2±4.2%; P<0.001). In multivariate logistic regression analysis for the incidence of subsequent pacemaker implantation (PMI), only RA-LVZ was a significant predictor of subsequent PMI (odd ratio 1.306; 95% confidence interval 1.159 - 1.473; P<0.001). Receiving-operating characteristic curve for PMI following ablation procedure indicated cut-off value 10.5% for RA-LVZ with 85.2% sensitivity and 88.1% specificity (area under curve = 0.924, P<0.001). Kaplan-Meier analysis of the incidence of PMI after AF termination showed that freedom from pacemaker implantation was significantly better in patients with RA-LVA <10.5% than in those with RA-LVZ ≥10.5% (log-rank test; P<0.001). Conclusions Broad RA-LVZ measured during AF was strongly associated with SND and PMI after AF termination in patients with Non-PAF. Evaluation of RA-LVZ during AF could be a potential target in predicting SND requiring PMI in patients with Non-PAF.

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