Atrial-based pacing has no benefit over ventricular pacing in preventing atrial arrhythmias in adults with congenital heart disease
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AIMS: To determine whether atrial-based pacing prevents atrial arrhythmias in adults with congenital heart disease (CHD) compared with ventricular pacing. METHODS AND RESULTS: All adult CHD patients from four participating centres with a permanent pacemaker were identified. Patients with permanent atrial arrhythmias at pacemaker implantation and patients who received a pacemaker for treatment of drug-refractory atrial arrhythmias were excluded. The final study population consisted of 211 patients (52% male, 36% complex CHD) who received a first pacemaker for sick sinus dysfunction (n = 82) or atrioventricular block (n = 129) at a median age of 24 years [interquartile range (IQR), 12-34]. A history of atrial arrhythmias at implantation was present in 49 patients (23%). Atrial-based pacing was the initial pacing mode in 139 patients (66%) while the others (34%) received ventricular pacing. During a median follow-up of 13 years (IQR, 7-21), 90 patients (43%) developed an atrial arrhythmia. Multivariate analysis demonstrated no significant effect of atrial-based pacing on subsequent atrial arrhythmias [hazard ratio (HR), 1.53; 95% confidence interval (CI), 0.91-2.56; P = 0.1]. Independent predictors of atrial arrhythmia were history of atrial arrhythmias (HR, 5.55; 95% CI, 3.47-8.89; P< 0.0001), older age (≥18 years) at pacemaker implantation (HR, 2.29; 95% CI, 1.29-4.04; P = 0.005), and complex CHD (HR, 1.57; 95% CI, 1.01-2.45; P = 0.04). CONCLUSION: In contrast to the general population, atrial-based pacing was not associated with a lower incidence of atrial arrhythmia in adults with CHD.
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Atrial-based pacing does not seem to prevent subsequent atrial arrhythmias according to multivariate analysis.
“Atrial-based pacing does not seem to prevent subsequent atrial arrhythmias according to multivariate analysis.371”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [371]
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- Authors
- Opic, P., Yap, S.-C., Van Kranenburg, M., Van Dijk, A. P., Budts, W., Vliegen, H. W., Van Erven, L., Can, A., Sahin, G., De Groot, N. M., Witsenburg, M., & Roos-Hesselink, J. W.
- Affiliations
- Erasmus MC (NL)
- Universitair Ziekenhuis Leuven (BE)
- Leiden University Medical Center (NL)
- Venue
- Europace
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-07-12
- Volume
- 15
- Issue
- 12
- Pages
- 1757-1762
- ISSN
- 1099-5129 (ISSN-L)
- 1532-2092
- OpenAlex
- W2121898580
- Cited by
- 17
- References
- 22
- Citations by year
- 2024: 1 · 2023: 2 · 2022: 2 · 2021: 3 · 2020: 1 · 2019: 1 · 2018: 3 · 2017: 1 · 2016: 2 · 2015: 1
- FWCI
- 0.68
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- EP Europace (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- Lirias (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- ventricular pacing, atrial arrhythmias, congenital heart disease, permanent pacemaker, sick sinus syndrome, atrioventricular block
- MeSH terms
- Adolescent, Adult, Age Factors, Arrhythmias, Cardiac, Belgium, Cardiac Pacing, Artificial, Child, Female, Heart Defects, Congenital, Humans, Male, Netherlands, Retrospective Studies, Risk Factors, Time Factors, Multivariate Analysis, Chi-Square Distribution, Proportional Hazards Models, Atrial Function, Ventricular Function, Treatment Outcome, Kaplan-Meier Estimate, Young Adult
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