Cited by 775Cardiac pacing and defibrillation studiesCardiac electrophysiology and arrhythmiasCardiac Health and Mental Health

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Effects of Physiologic Pacing versus Ventricular Pacing on the Risk of Stroke and Death Due to Cardiovascular Causes

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Connolly, Stuart J., Kerr, Charles R., Gent, Michael, Roberts, Robin S., Yusuf, Salim, Gillis, Anne M., Sami, Magdi H., Talajic, Mario, Tang, Anthony S.L., Klein, George J., Lau, Ching, Newman, David M.·2000·New England Journal of Medicine

DOI 10.1056/nejm200005113421902

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Abstract

BACKGROUND: Evidence suggests that physiologic pacing (dual-chamber or atrial) may be superior to single-chamber (ventricular) pacing because it is associated with lower risks of atrial fibrillation, stroke, and death. These benefits have not been evaluated in a large, randomized, controlled trial. METHODS: At 32 Canadian centers, patients without chronic atrial fibrillation who were scheduled for a first implantation of a pacemaker to treat symptomatic bradycardia were eligible for enrollment. We randomly assigned patients to receive either a ventricular pacemaker or a physiologic pacemaker and followed them for an average of three years. The primary outcome was stroke or death due to cardiovascular causes. Secondary outcomes were death from any cause, atrial fibrillation, and hospitalization for heart failure. RESULTS: A total of 1474 patients were randomly assigned to receive a ventricular pacemaker and 1094 to receive a physiologic pacemaker. The annual rate of stroke or death due to cardiovascular causes was 5.5 percent with ventricular pacing, as compared with 4.9 percent with physiologic pacing (reduction in relative risk, 9.4 percent; 95 percent confidence interval, -10.5 to 25.7 percent [the negative value indicates an increase in risk]; P=0.33). The annual rate of atrial fibrillation was significantly lower among the patients in the physiologic-pacing group (5.3 percent) than among those in the ventricular-pacing group (6.6 percent), for a reduction in relative risk of 18.0 percent (95 percent confidence interval, 0.3 to 32.6 percent; P=0.05). The effect on the rate of atrial fibrillation was not apparent until two years after implantation. The observed annual rates of death from all causes and of hospitalization for heart failure were lower among the patients with a physiologic pacemaker than among those with a ventricular pacemaker, but not significantly so (annual rates of death, 6.6 percent with ventricular pacing and 6.3 percent with physiologic pacing; annual rates of hospitalization for heart failure, 3.5 percent and 3.1 percent, respectively). There were significantly more perioperative complications with physiologic pacing than with ventricular pacing (9.0 percent vs. 3.8 percent, P<0.001). CONCLUSIONS: Physiologic pacing provides little benefit over ventricular pacing for the prevention of stroke or death due to cardiovascular causes.

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ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation31This document was approved by the American College of Cardiology Board of Trustees in August 2001, the American Heart Association Science Advisory and Coordinating Committee in August 2001, and the European Society of Cardiology Board and Committee for Practice Guidelines and Policy Conferences in August 2001.32When citing this document, the American College of Cardiology, the American Heart Association, and the European Society of Cardiology would appreciate the following citation format: Fuster V, Rydén LE, Asinger RW, Cannom DS, Crijns HJ, Frye RL, Halperin JL, Kay GN, Klein WW, Lévy S, McNamara RL, Prystowsky EN, Wann LS, Wyse DG. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation). J Am Coll Cardiol 2001;38:XX-XX.33This document is available on the World Wide Web sites of the American College of Cardiology (www.acc.org), the American Heart Association (www.americanheart.org), the European Society of Cardiology (www.escardio.org), and the North American Society of Pacing and Electrophysiology (www.naspe.org). Single reprints of this document (the complete Guidelines) to be published in the mid-October issue of the European Heart Journal are available by calling +44.207.424.4200 or +44.207.424.4389, faxing +44.207.424.4433, or writing Harcourt Publishers Ltd, European Heart Journal, ESC Guidelines – Reprints, 32 Jamestown Road, London, NW1 7BY, United Kingdom. Single reprints of the shorter version (Executive Summary and Summary of Recommendations) published in the October issue of the Journal of the American College of Cardiology and the October issue of Circulation, are available for $5.00 each by calling 800-253-4636 (US only) or by writing the Resource Center, American College of Cardiology, 9111 Old Georgetown Road, Bethesda, Maryland 20814. To purchase bulk reprints specify version and reprint number (Executive Summary 71-0208; full text 71-0209) up to 999 copies, call 800-611-6083 (US only) or fax 413-665-2671; 1000 or more copies, call 214-706-1466, fax 214-691-6342; or E-mail: pubauth@heart.org.
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Authors: Connolly, S. J., Kerr, C. R., Gent, M., Roberts, R. S., Yusuf, S., Gillis, A. M., Sami, M. H., Talajic, M., Tang, A. S. L., Klein, G. J., Lau, C., & Newman, D. M.
Affiliations: McMaster University (CA)
University of British Columbia (CA)
University of Calgary (CA)
McGill University (CA)
Montreal Heart Institute (CA)
University of Ottawa (CA)
Western University (CA)
University of Toronto (CA)
ORCID: Connolly, Stuart J.
Yusuf, Salim
Gillis, Anne M.
Talajic, Mario
Klein, George J.
Newman, David M.
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 2000-05-11
Volume: 342
Issue: 19
Pages: 1385-1391
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejm200005113421902
OpenAlex: W2332653577
Cited by: 775
References: 16
Citations by year: 2026: 8 · 2025: 9 · 2024: 8 · 2023: 16 · 2022: 14 · 2021: 14 · 2020: 21 · 2019: 19 · 2018: 23 · 2017: 15 · 2016: 26 · 2015: 25 · 2014: 23 · 2013: 28 · 2012: 35
FWCI: 31.24
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
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 › Cardiac Health and Mental Health
Keywords: physiological pacing, ventricular pacing, dual-chamber pacemaker, atrial pacing, bradycardia, pacemaker implantation, stroke, cardiovascular mortality, atrial fibrillation, heart failure hospitalization, perioperative complications, symptomatic bradycardia
MeSH terms: Aged, Atrial Fibrillation, Bradycardia, Cardiac Pacing, Artificial, Cardiovascular Diseases, Female, Heart Block, Humans, Male, Pacemaker, Artificial, Risk, Stroke

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Effects of Physiologic Pacing versus Ventricular Pacing on the Risk of Stroke and Death Due to Cardiovascular Causes

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