Long-term follow-up of patients from a randomised trial of atrial versus ventricular pacing for sick-sinus syndrome
Abstract
Background In a previous study of 225 patients with sick-sinus syndrome randomised to either single-chamber atrial pacing (n=110) or single-chamber ventricular pacing (n=115), we found that after a mean follow-up of 3.3 years, atrial pacing was associated with significantly less atrial fibrillation and thromboembolism whereas there was no significant difference in mortality and heart failure between the two groups. We aimed to find out whether this beneficial effect of atrial pacing is maintained during extended follow-up of up to 8 years.Methods Follow-up visits for all patients were at 3 months, 12 months, then once a year at which patients had a physical examination, ECG recording, and pacemaker check-up. Endpoints were mortality, cardiovascular death, atrial fibrillation, thromboembolic events, heart failure, and atrioventricular block. Data was analysed on Dec 31, 1996.Findings At long-term follow-up, 39 patients from the atrial group had died versus 57 from the ventricular group (relative risk 0.66 [95% CI 0.44-0.99]; p=0.045). 19 patients from the atrial group and 39 patients from the ventricular group died from a cardiovascular cause (0.47 [0.27-0.82]; p=0.0065). The cumulative incidences of atrial fibrillation and chronic atrial fibrillation were also significantly lower in the atrial group than in the ventricular group (0.54 [0.33-0.89], p=0.012 and 0.35 [0.16-0.76], p=0.004, respectively). Thromboembolic events occurred in 13 patients in the atrial group and 26 in the ventricular group (0.47 [0.24-0.92], p=0.023). Heart failure was less severe in the atrial group than in the ventricular group (p<0.05). In multivariate analysis, atrial pacing was significantly associated with freedom from thromboembolic events (0.47 [0.24-0.92], p=0.028) and survival from cardiovascular death (0.52 [0.30-0.91], p=0.022), but no longer with overall survival (0.71 [0.46-1.08], p=0.11) or chronic atrial fibrillation (0.45 [0.20-1.05], p=0.063). Atrioventricular block occurred in four patients in the atrial group (0.6% annual risk).Interpretation The beneficial effect of atrial pacing found in our previous study is enhanced substantially over time. Patients with sick-sinus syndrome should be treated with an atrial rather than ventricular-pacing system because after long-term follow-up, atrial pacing is associated with a significantly higher survival, less atrial fibrillation, fewer thromboembolic complications, less heart failure, and a low-risk of atrioventricular block.
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In selected patients with sick sinus syndrome and fast ventricular response during AF paroxysms requiring rate control therapy, the addition of a pacemaker optimizes rate control and may help to control rhythm.
“In selected patients with sick sinus syndrome and fast ventricular response during AF paroxysms requiring rate control therapy, the addition of a pacemaker not only optimizes rate control but may also help to control rhythm.711,712”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [711]
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- Authors
- Andersen, H. R., Nielsen, J. C., Thomsen, P. E. B., Thuesen, L., Mortensen, P. T., Vesterlund, T., & Pedersen, A. K.
- Affiliations
- Aarhus University Hospital (DK)
- Corresponding author
- Andersen, Henning Rud
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 1997-10
- Volume
- 350
- Issue
- 9086
- Pages
- 1210-1216
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2110807802
- Cited by
- 841
- References
- 31
- Citations by year
- 2026: 7 · 2025: 5 · 2024: 9 · 2023: 14 · 2022: 12 · 2021: 11 · 2020: 14 · 2019: 11 · 2018: 17 · 2017: 24 · 2016: 18 · 2015: 25 · 2014: 23 · 2013: 26 · 2012: 33
- FWCI
- 24.93
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Hjerteforeningen
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Keywords
- sick sinus syndrome, atrial pacing, ventricular pacing, single-chamber pacemaker, atrial fibrillation, thromboembolism, cardiovascular mortality, heart failure, atrioventricular block, long-term outcomes, pacemaker implantation, atrioventricular conduction disorders, atrial tachyarrhythmia, atrial fibrillation prevention
- MeSH terms
- Aged, Atrial Fibrillation, Cardiac Pacing, Artificial, Female, Follow-Up Studies, Heart Block, Heart Failure, Humans, Male, Morbidity, Pacemaker, Artificial, Risk Factors, Sick Sinus Syndrome, Thromboembolism, Time Factors, Survival Rate, Multivariate Analysis
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