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Article ; Online: Pacing mode selection in patients with sick sinus syndrome.

Nielsen, Jens Cosedis

2007 Volume 54, Issue 1, Page(s) 1–17

MeSH term(s)	Cardiac Pacing, Artificial/methods ; Denmark ; Echocardiography, Doppler ; Electrocardiography ; Female ; Humans ; Male ; Pacemaker, Artificial ; Prognosis ; Prospective Studies ; Randomized Controlled Trials as Topic ; Risk Assessment ; Severity of Illness Index ; Sick Sinus Syndrome/diagnosis ; Sick Sinus Syndrome/mortality ; Sick Sinus Syndrome/therapy ; Survival Analysis ; Treatment Outcome
Language	English
Publishing date	2007-02
Publishing country	Denmark
Document type	Journal Article ; Review
ZDB-ID	124108-4
ISSN	1603-9629 ; 0011-6092 ; 0901-6929 ; 0907-8916
ISSN (online)	1603-9629
ISSN	0011-6092 ; 0901-6929 ; 0907-8916
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Article ; Online: Permanent single-chamber atrial pacing: an obsolete or viable alternative to dual-chamber pacing in selected patients with sinus node disease?

Kuniewicz, Marcin / Stanek, Adrian / Ząbek, Andrzej / Kacprzyk, Marta / Gosnell, Marc / Dębski, Maciej / Lelakowski, Jacek

Polish archives of internal medicine

2023 Volume 133, Issue 12

Abstract: ... in sick sinus syndrome and significant bradycardia.: Objective: The study aimed to evaluate long‑term AAI pacing and ... to identify timing and reasons for pacing mode change.: Patients and methods: Retrospectively, we included ... Results: At the time of death or loss to follow‑up, 71 patients (34.3%) had unchanged AAI pacing mode ...

Abstract	Introduction: Single atrial stimulation (AAI) has been commonly used for permanent pacing in sick sinus syndrome and significant bradycardia. Objective: The study aimed to evaluate long‑term AAI pacing and to identify timing and reasons for pacing mode change. Patients and methods: Retrospectively, we included 207 patients (60% women) with initial AAI pacing, who were followed‑up for an average of 12 years. Results: At the time of death or loss to follow‑up, 71 patients (34.3%) had unchanged AAI pacing mode. The reason for an upgrade of the pacing system was development of atrial fibrillation (AF) in 43 patients (20.78%) and atrioventricular block (AVB) in 34 patients (16.4%). The cumulative ratio for a pacemaker upgrade reoperation reached 2.77 per 100 patient‑years of the follow‑up. Cumulative ventricular pacing below 10% after an upgrade to dual‑chamber pacemaker was observed in 28.6% of the patients. Younger age at implant was the leading independent predictor of the change to dual‑chamber simulation (hazard ratio, 1.98; 95% CI, 1.976-1.988; P = 0.001). There were 11 (5%) lead malfunctions that required reoperation. Subclavian vein occlusion was noted in 9 upgrade procedures (11%). One cardiac device-related infection was observed. Conclusions: The reliability of AAI pacing decreases with each year of observation due to development of AF and AVB. However, in the current era of effective AF treatment, the advantages of AAI pacemakers, such as lower incidence of lead malfunction, venous occlusion, and infection, as compared with dual-chamber pacemakers, may make AAI pacemakers a viable option.
MeSH term(s)	Humans ; Female ; Male ; Sick Sinus Syndrome/therapy ; Retrospective Studies ; Reproducibility of Results ; Pacemaker, Artificial ; Heart Atria ; Atrial Fibrillation/therapy
Language	English
Publishing date	2023-05-25
Publishing country	Poland
Document type	Journal Article
ZDB-ID	123500-x
ISSN	1897-9483 ; 0032-3772
ISSN (online)	1897-9483
ISSN	0032-3772
DOI	10.20452/pamw.16509
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Article ; Online: AAI – the forgotten pacing mode

Szymon Domagała / Anna Polewczyk / Łukasz Zandecki / Marianna Janion

Studia Medyczne, Vol 33, Iss 1, Pp 63-

2017 Volume 66

Abstract: For a long time the AAI pacing mode was commonly used in patients with sick sinus syndrome ... patients with sick sinus syndrome. ... pacing mode has many forgotten advantages and it could still be successfully used in well selected ...

Abstract	For a long time the AAI pacing mode was commonly used in patients with sick sinus syndrome, who were treated with pacemaker. After the guideline recommendations were updated in 2013 the AAI mode was displaced by the DDDR mode, especially with atrioventricular delay management. The most important argument for this change was the risk of the development of advanced atrioventricular block in long-term observation. This situation may require changing the pacing mode to DDD and implanting a ventricular lead. However, the AAI pacing mode has many forgotten advantages and it could still be successfully used in well selected patients with sick sinus syndrome.
Keywords	pacing ; sick sinus syndrome ; AAI mode ; DDD mode ; Medicine ; R
Language	English
Publishing date	2017-03-01T00:00:00Z
Publisher	Termedia Publishing House
Document type	Article ; Online
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Article: Selecting the appropriate pacing mode for patients with sick sinus syndrome: evidence from randomized clinical trials.

Albertsen, A E / Nielsen, J C

Cardiac electrophysiology review

2003 Volume 7, Issue 4, Page(s) 406–410

Abstract: ... with sick sinus syndrome (SSS). In pacing mode selection, VVI(R) pacing is the least attractive solution, increasing ... we present and discuss the most recent data from six randomized trials on mode selection in patients ... death. VVI(R) pacing should not be used as the primary pacing mode in patients with SSS, who haven't ...

Abstract	Several observational studies have indicated that selection of pacing mode may be important for the clinical outcome in patients with symptomatic bradycardia, affecting the development of atrial fibrillation (AF), thromboembolism, congestive heart failure, mortality and quality of life. In this paper we present and discuss the most recent data from six randomized trials on mode selection in patients with sick sinus syndrome (SSS). In pacing mode selection, VVI(R) pacing is the least attractive solution, increasing the incidence of AF and-as compared with AAI(R) pacing, also the incidence of heart failure, thromboembolism and death. VVI(R) pacing should not be used as the primary pacing mode in patients with SSS, who haven't chronic AF. AAIR pacing is superior to DDDR pacing, reducing AF and preserving left ventricular function. Single site right ventricular pacing-VVI(R) or DDD(R) mode-causes an abnormal ventricular activation and contraction (called ventricular desynchronization), which results in a reduced left ventricular function. Despite the risk of AV block, we consider AAIR pacing to be the optimal pacing mode for isolated SSS today and an algorithm to select patients for AAIR pacing is suggested. Trials on new pacemaker algorithms minimizing right ventricular pacing as well as trials testing alternative pacing sites and multisite pacing to reduce ventricular desynchronization can be expected within the next years.
MeSH term(s)	Cardiac Pacing, Artificial/methods ; Heart Atria/physiopathology ; Heart Ventricles/physiopathology ; Humans ; Randomized Controlled Trials as Topic ; Sick Sinus Syndrome/therapy ; Treatment Outcome ; Ventricular Function, Left
Language	English
Publishing date	2003-12
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1360994-4
ISSN	1385-2264
ISSN	1385-2264
DOI	10.1023/B:CEPR.0000023156.58418.2a
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Article ; Online: VVI pacing with normal QRS duration and ventricular function: MOST trial findings relevant to leadless pacemakers.

Loring, Zak / North, Rebecca / Hellkamp, Anne S / Atwater, Brett D / Frazier-Mills, Camille G / Jackson, Kevin P / Pokorney, Sean D / Lamas, Gervasio A / Piccini, Jonathan P

Pacing and clinical electrophysiology : PACE

2020 Volume 43, Issue 12, Page(s) 1461–1466

Abstract: ... without atrioventricular synchrony (VVIR mode). The Mode Selection Trial in Sinus Node Dysfunction (MOST) showed similar ... outcomes by pacing mode in LP-eligible patients from MOST.: Methods: Patients enrolled in the MOST study ... with transvenous leads and device pockets. LPs are appealing for patients who need pacing, but do not need ...

Abstract	Background: Leadless pacemakers (LPs) provide ventricular pacing without the risks associated with transvenous leads and device pockets. LPs are appealing for patients who need pacing, but do not need defibrillator or cardiac resynchronization therapy. Most implanted LPs provide right ventricular pacing without atrioventricular synchrony (VVIR mode). The Mode Selection Trial in Sinus Node Dysfunction (MOST) showed similar outcomes in patients randomized to dual-chamber (DDDR) versus ventricular pacing (VVIR). We compared outcomes by pacing mode in LP-eligible patients from MOST. Methods: Patients enrolled in the MOST study with an left ventricular ejection fraction (LVEF) >35%, QRS duration (QRSd) <120 ms and no history of ventricular arrhythmias or prior implantable cardioverter defibrillators were included (LP-eligible population). Cox proportional hazards models were used to test the association between pacing mode and death, stroke or heart failure (HF) hospitalization and atrial fibrillation (AF). Results: Of the 2010 patients enrolled in MOST, 1284 patients (64%) met inclusion criteria. Baseline characteristics were well balanced across included patients randomized to DDDR (N = 630) and VVIR (N = 654). Over 4 years of follow-up, there was no association between pacing mode and death, stroke or HF hospitalization (VVIR HR 1.28 [0.92-1.75]). VVIR pacing was associated with higher risk of AF (HR 1.32 [1.08-1.61], P = .007), particularly in patients with no history of AF (HR 2.38 [1.52-3.85], P < .001). Conclusion: In patients without reduced LVEF or prolonged QRSd who would be eligible for LP, DDDR, and VVIR pacing demonstrated similar rates of death, stroke or HF hospitalization; however, VVIR pacing significantly increased the risk of AF development.
MeSH term(s)	Aged ; Aged, 80 and over ; Atrial Fibrillation/physiopathology ; Atrial Fibrillation/therapy ; Cardiac Pacing, Artificial/methods ; Equipment Design ; Female ; Humans ; Male ; Pacemaker, Artificial ; Sick Sinus Syndrome/physiopathology ; Sick Sinus Syndrome/therapy ; United States
Language	English
Publishing date	2020-11-05
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Randomized Controlled Trial
ZDB-ID	424437-0
ISSN	1540-8159 ; 0147-8389
ISSN (online)	1540-8159
ISSN	0147-8389
DOI	10.1111/pace.14100
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Zs.A 1466: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article: Atrial pacing, the forgotten pacing mode.

El Gamal, M

Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation

2007 Volume 16, Issue Suppl 1, Page(s) S25–7

Abstract: ... a place for atrial pacing in selected patients with sick sinus syndrome with a minimum risk of developing ... In patients with sick sinus syndrome and normal atrioventricular conduction, physiological pacing ... with sick sinus syndrome. Recent publications have reported an increase in left atrial diameter, decrease ...

Abstract	In patients with sick sinus syndrome and normal atrioventricular conduction, physiological pacing can be accomplished with either a single chamber atrial pacemaker AAI/R or a dual chamber pacemaker DDD/R. The single chamber device has the advantages of simpler implantation and lower initial costs, while the dual chamber device offers protection in case atrioventricular conduction disturbances develop in the future. When rigorous attention is paid to the pre-implantation selection criteria, the incidence of reported second- or third-degree atrioventricular block varied between 0.4 and 1.8% per annum. Medical practice, however, has shifted to predominant implantation of DDD/R pacemakers in more than 95% of patients with sick sinus syndrome. Recent publications have reported an increase in left atrial diameter, decrease in left ventricular fractional shortening and increased incidence of atrial fibrillation in patients with DDD/R pacing as compared with patients with single chamber atrial devices. These changes were proportional to the percentage of ventricular paced beats.New algorithms in dual chamber devices have been developed in order to minimise ventricular stimulation. These are being evaluated at present. In my opinion there is still a place for atrial pacing in selected patients with sick sinus syndrome with a minimum risk of developing complete atrioventricular block. (Neth Heart J 2008;16(Suppl1):S25-S27.).
Language	English
Publishing date	2007-11-02
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2211468-3
ISSN	1876-6250 ; 1568-5888 ; 0929-7456
ISSN (online)	1876-6250
ISSN	1568-5888 ; 0929-7456
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Article ; Online: Spanish Pacemaker Registry. 16th Official Report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2018).

Cano Pérez, Óscar / Pombo Jiménez, Marta / Lorente Carreño, Diego / Chimeno García, Javier

Revista espanola de cardiologia (English ed.)

2019 Volume 72, Issue 11, Page(s) 944–953

Abstract: ... chamber VVI/R pacing was used in 28% of patients with sick sinus syndrome and in 24.7 ... the most frequent pacing mode but was less frequently used in patients aged> 80 years and in women. Single ... in cardiac resynchronization therapy with pacemaker generators. Selection of pacing mode was directly influenced by age and sex. ...

Abstract	Introduction and objectives: This report describes the result of the analysis of the implanted pacemakers reported to the Spanish Pacemaker Registry in 2018. Methods: The analysis is based on the information provided by the European Pacemaker Identification Card and supplier-reported data on the overall number of implanted pacemakers. Results: Information was received from 90 hospitals, with a total of 12 148 cards, representing 31% of the estimated activity. Use of conventional and resynchronization pacemakers was 825 and 77 units per million people, respectively. The mean age of the patients receiving an implant was 78.3 years, and 54% of the devices were implanted in people aged> 80 years. A total of 77.1% were first implants and 21.6% corresponded to generator exchanges. Bicameral sequential pacing was the most frequent pacing mode but was less frequently used in patients aged> 80 years and in women. Single chamber VVI/R pacing was used in 28% of patients with sick sinus syndrome and in 24.7% of those with atrioventricular block, despite being in sinus rhythm. Conclusions: The total consumption of pacemaker generators in Spain increased by 1.2% compared with 2017, mainly due to an 8.7% increase in cardiac resynchronization therapy with pacemaker generators. Selection of pacing mode was directly influenced by age and sex.
MeSH term(s)	Aged ; Aged, 80 and over ; Arrhythmias, Cardiac/epidemiology ; Arrhythmias, Cardiac/therapy ; Cardiology ; Female ; Humans ; Incidence ; Male ; Pacemaker, Artificial/statistics & numerical data ; Registries ; Societies, Medical ; Spain/epidemiology
Language	Spanish
Publishing date	2019-10-18
Publishing country	Spain
Document type	Journal Article ; Multicenter Study
ZDB-ID	2592481-3
ISSN	1885-5857 ; 1885-5857
ISSN (online)	1885-5857
ISSN	1885-5857
DOI	10.1016/j.rec.2019.07.014
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Article ; Online: Neuroendocrine and haemodynamic changes in single-lead atrial pacing and dual-chamber pacing modes.

Zhang, Ying-ying / Wu, Dong-yan / Fu, Nai-kuan / Lu, Feng-min / Xu, Jing

The Journal of international medical research

2013 Volume 41, Issue 4, Page(s) 1057–1066

Abstract: ... in DDD than in AAI mode.: Conclusions: In patients with sick sinus syndrome, DDD pacing mode ... or dual-chamber (DDD) pacing modes in patients with sick sinus syndrome, in a crossover study ... These findings discourage the routine use of DDD pacing in patients with sick sinus syndrome. ...

Abstract	Objectives: Neuroendocrine and haemodynamic changes were compared between single-lead atrial (AAI) or dual-chamber (DDD) pacing modes in patients with sick sinus syndrome, in a crossover study. Methods: Inpatients scheduled for their first pacemaker implantation were screened for the following inclusion criteria: sick sinus syndrome; intact atrioventricular conduction; normal QRS interval. All study patients were implanted with a dual-chamber pacemaker, programmed for AAI or DDD pacing mode. Patients were allocated randomly to AAI followed by DDD pacing or to DDD followed by AAI pacing, each mode being applied for 72 h. Echocardiographic, electrocardiographic and neuroendocrine parameters were tested at the end of each pacing mode. Results: From 152 inpatients screened for inclusion, 28 were selected for treatment. Plasma levels of atrial natriuretic peptide (ANP), endothelin, aldosterone and angiotension II were significantly lower, and aortic flow velocity-time integral was significantly higher, in AAI mode than in DDD mode. Aortic pre-ejection interval, interventricular mechanical delay and QRS duration were significantly higher in DDD than in AAI mode. Conclusions: In patients with sick sinus syndrome, DDD pacing mode can induce neuroendocrine system activation, and left ventricular dysfunction and dyssynchrony. These findings discourage the routine use of DDD pacing in patients with sick sinus syndrome.
MeSH term(s)	Aged ; Aldosterone/blood ; Angiotensin II/blood ; Atrial Natriuretic Factor/blood ; Blood Flow Velocity ; Cross-Over Studies ; Endothelins/blood ; Female ; Heart Atria/metabolism ; Heart Atria/physiopathology ; Heart Atria/surgery ; Heart Rate ; Humans ; Male ; Middle Aged ; Pacemaker, Artificial/adverse effects ; Sick Sinus Syndrome/blood ; Sick Sinus Syndrome/physiopathology ; Sick Sinus Syndrome/surgery ; Time Factors ; Ventricular Dysfunction, Left/blood ; Ventricular Dysfunction, Left/etiology ; Ventricular Dysfunction, Left/physiopathology
Chemical Substances	Endothelins ; Angiotensin II (11128-99-7) ; Aldosterone (4964P6T9RB) ; Atrial Natriuretic Factor (85637-73-6)
Language	English
Publishing date	2013-08
Publishing country	England
Document type	Journal Article
ZDB-ID	184023-x
ISSN	1473-2300 ; 0300-0605 ; 0142-2596
ISSN (online)	1473-2300
ISSN	0300-0605 ; 0142-2596
DOI	10.1177/0300060513489798
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Article ; Online: Effect of PR interval and pacing mode on persistent atrial fibrillation incidence in dual chamber pacemaker patients: a sub-study of the international randomized MINERVA trial.

Boriani, Giuseppe / Pieragnoli, Paolo / Botto, Giovanni Luca / Puererfellner, Helmut / Mont, Lluis / Ziacchi, Matteo / Manolis, Antonis S / Gulizia, Michele / Tukkie, Raymond / Landolina, Maurizio / Ricciardi, Giuseppe / Cicconelli, Manuele / Grammatico, Andrea / Biffi, Mauro

Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology

2019 Volume 21, Issue 4, Page(s) 636–644

Abstract: ... pacing mode. Persistent AF incidence was lower in short PR patients treated by right ventricular pacing ... in MVP mode compared with DDDR mode and it was lower (HR 0.65, 95% CI 0.43-0.99; P = 0.049) in patients ... in long PR patients, and managed ventricular pacing (MVP), to avoid ventricular desynchronization imposed ...

Abstract	Aims: Per standard of care, dual-chamber pacemakers are programmed in DDDR mode with fixed atrioventricular (AV) delay or with long AV delay to minimize ventricular pacing. We aimed to evaluate whether the PR interval may be a specific criterion of choice between standard DDDR, to preserve AV synchrony in long PR patients, and managed ventricular pacing (MVP), to avoid ventricular desynchronization imposed by right ventricle apical pacing, in short PR patients. Methods and results: In the MINERVA trial, 1166 patients were randomized to Control DDDR, MVP, or atrial anti-tachycardia pacing plus MVP (DDDRP + MVP). We evaluated the interaction of PR interval with pacing mode by comparing the risk of atrial fibrillation (AF) longer than 7 consecutive days as a function of PR interval. Out of 906 patients with available data, the median PR interval was 180 ms. The PR interval was found to significantly (P = 0.012) interact with pacing mode for AF incidence: the risk of AF > 7 days was lower [hazard ratio (HR) 0.58, 95% confidence interval (95% CI) 0.34-0.99; P = 0.047] in patients with short PR (shorter than median PR) if programmed in MVP mode compared with DDDR mode and it was lower (HR 0.65, 95% CI 0.43-0.99; P = 0.049) in patients with long PR (equal to or longer than median PR) if programmed in DDDR mode compared with MVP. Conclusion: Our data show that PR interval may be used as a selection criterion to identify the optimal physiological pacing mode. Persistent AF incidence was lower in short PR patients treated by right ventricular pacing minimization and in long PR patients treated by standard dual-chamber pacing.
MeSH term(s)	Aged ; Aged, 80 and over ; Algorithms ; Arrhythmias, Cardiac/physiopathology ; Arrhythmias, Cardiac/therapy ; Atrial Fibrillation/epidemiology ; Atrial Fibrillation/physiopathology ; Atrioventricular Block/physiopathology ; Cardiac Pacing, Artificial/methods ; Electrocardiography ; Female ; Humans ; Incidence ; Interatrial Block/physiopathology ; Male ; Middle Aged ; Pacemaker, Artificial ; Prognosis ; Proportional Hazards Models ; Sick Sinus Syndrome/physiopathology ; Sick Sinus Syndrome/therapy
Language	English
Publishing date	2019-01-15
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	1449879-0
ISSN	1532-2092 ; 1099-5129
ISSN (online)	1532-2092
ISSN	1099-5129
DOI	10.1093/europace/euy286
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Article ; Online: Spanish Pacemaker Registry. 14th Official Report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2016).

Cano Pérez, Óscar / Pombo Jiménez, Marta / Fidalgo Andrés, María Luisa / Lorente Carreño, Diego / Coma Samartín, Raúl

Revista espanola de cardiologia (English ed.)

2017 Volume 70, Issue 12, Page(s) 1083–1097

Abstract: ... R) was used in 26.7% of the patients with sick sinus syndrome and in 23.8 ... magnetic resonance imaging protection. Age and sex directly influenced pacing mode selection, which could be improved ... magnetic resonance imaging protection. Most patients received bicameral sequential pacing, although single chamber pacing VVI ...

Abstract	Introduction and objectives: This report describes the results of analysis of implanted pacemakers reported to the Spanish Pacemaker Registry. Methods: The analysis was based on information provided by the European Pacemaker Identification Card. Results: Information was received from 115 hospitals, with a total of 12 697 cards, representing 32.3% of the estimated activity. Use of conventional and resynchronization pacemakers was 818 and 79 units per million inhabitants, respectively. A total of 200 leadless pacemakers were implanted. The mean age of the patients receiving an implant was 77.8 years, and 52% of devices were implanted in persons older than 80 years. In all, 74.9% were first implants and 23.4% corresponded to generator exchange. Endocardial leads were bipolar, 82.9% with active fixation, and 16.1% had magnetic resonance imaging protection. Most patients received bicameral sequential pacing, although single chamber pacing VVI(R) was used in 26.7% of the patients with sick sinus syndrome and in 23.8% of those with atrioventricular block, despite sinus rhythm. Conclusions: Total use of pacemaker generators in Spain has increased by 1.6% compared with 2015. Most implanted leads have active fixation and less than 20% have magnetic resonance imaging protection. Age and sex directly influenced pacing mode selection, which could be improved in around 32% of patients.
MeSH term(s)	Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Arrhythmias, Cardiac/therapy ; Atrioventricular Block/therapy ; Cardiac Pacing, Artificial/methods ; Cardiac Resynchronization Therapy/methods ; Cardiac Resynchronization Therapy Devices ; Cardiology ; Child ; Female ; Humans ; Male ; Middle Aged ; Pacemaker, Artificial ; Registries ; Sex Factors ; Sick Sinus Syndrome/therapy ; Societies, Medical ; Spain ; Young Adult
Language	Spanish
Publishing date	2017-12
Publishing country	Spain
Document type	Journal Article
ISSN	1885-5857
ISSN (online)	1885-5857
DOI	10.1016/j.rec.2017.08.017
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