Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction

Sweeney, Michael O.; Hellkamp, Anne S.; Ellenbogen, Kenneth A.; Greenspon, Arnold J.; Freedman, Roger A.; Lee, Kerry L.; Lamas, Gervasio A.

doi:10.1161/01.cir.0000072769.17295.b1

Cited by 1,773Cardiac pacing and defibrillation studiesCardiac electrophysiology and arrhythmiasCardiac Health and Mental Health

Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction

Sweeney, Michael O., Hellkamp, Anne S., Ellenbogen, Kenneth A., Greenspon, Arnold J., Freedman, Roger A., Lee, Kerry L., Lamas, Gervasio A.·2003·Circulation

DOI 10.1161/01.cir.0000072769.17295.b1

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Abstract

Background— Dual-chamber (DDDR) pacing preserves AV synchrony and may reduce heart failure (HF) and atrial fibrillation (AF) compared with ventricular (VVIR) pacing in sinus node dysfunction (SND). However, DDDR pacing often results in prolonged QRS durations (QRSd) as the result of right ventricular stimulation, and ventricular desynchronization may result. The effect of pacing-induced ventricular desynchronization in patients with normal baseline QRSd is unknown. Methods and Results— Baseline QRSd was obtained from 12-lead ECGs before pacemaker implantation in MOST, a 2010-patient, 6-year, randomized trial of DDDR versus VVIR pacing in SND. Cumulative percent ventricular paced (Cum%VP) was determined from stored pacemaker data. Baseline QRSd <120 ms was observed in 1339 patients (707 DDDR, 632 VVIR). Cum%VP was greater in DDDR versus VVIR (90% versus 58%, P =0.001). Cox models demonstrated that the time-dependent covariate Cum%VP was a strong predictor of HF hospitalization in DDDR (hazard ratio [HR], 2.99 [95% CI, 1.15 to 7.75] for Cum%VP >40%) and VVIR (HR 2.56 [95% CI, 1.48 to 4.43] for Cum%VP >80%). The risk of AF increased linearly with Cum%VP from 0% to 85% in both groups (DDDR, HR 1.36 [95% CI, 1.09, 1.69]; VVIR, HR 1.21 [95% CI 1.02, 1.43], for each 25% increase in Cum%VP). Model results were unaffected by adjustment for known baseline predictors of HF hospitalization and AF. Conclusions— Ventricular desynchronization imposed by ventricular pacing even when AV synchrony is preserved increases the risk of HF hospitalization and AF in SND with normal baseline QRSd.

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In patients with intact AV conduction, higher rates of unnecessary ventricular pacing are associated with risks of heart failure and atrial fibrillation, as well as greater current drain on the pacemaker battery.
“In patients with intact AV conduction, programming should try to minimize ventricular pacing due to the risks of heart failure and atrial fibrillation with higher rates of unnecessary ventricular pacing, as well as greater current drain on the pacemaker battery [13] .”
From Evaluating and managing bradycardia (2020) · cites this paper as [13]
The Discussion and Atrial Fibrillation sections associate more frequent ventricular pacing with heart-failure hospitalization and atrial fibrillation, and the Discussion suggests that minimizing ventricular pacing may reduce those risks. The study concerns patients with sinus node dysfunction and normal baseline QRS duration, rather than all patients with intact AV conduction. Our copy does not address the claimed greater current drain on the pacemaker battery. (LLM, conf=0.88)
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[21]21. Sweeney MO, Shea JB, Fox V, et al. Randomized trial of a new minimal ventricular pacing mode in dual chamber ICDs. Pacing Clin Electro- physiol. 2003;26:973. Abstract.

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Authors: Sweeney, M. O., Hellkamp, A. S., Ellenbogen, K. A., Greenspon, A. J., Freedman, R. A., Lee, K. L., & Lamas, G. A.
Affiliations: Brigham and Women's Hospital (US)
Corresponding author: Sweeney, Michael O.
ORCID: Hellkamp, Anne S.
Ellenbogen, Kenneth A.
Greenspon, Arnold J.
Freedman, Roger A.
Lee, Kerry L.
Lamas, Gervasio A.
Venue: Circulation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2003-06-17
Volume: 107
Issue: 23
Pages: 2932-2937
ISSN: 0009-7322 (ISSN-L)
1524-4539
DOI: 10.1161/01.cir.0000072769.17295.b1
OpenAlex: W1992880616
Semantic Scholar: f64ee53940d6857ca50be244f1edf56583485f93
Cited by: 1,773
References: 22
Citations by year: 2026: 63 · 2025: 87 · 2024: 79 · 2023: 109 · 2022: 79 · 2021: 94 · 2020: 80 · 2019: 68 · 2018: 82 · 2017: 74 · 2016: 71 · 2015: 70 · 2014: 69 · 2013: 66 · 2012: 75
FWCI: 46.73
Type: journal article
Language: en
Open access: closed
Locations: Circulation (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (5u01hl053973-05)
National Heart, Lung, and Blood Institute (U01HL049804, U01 HL 53973, U01-HL-49804)
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: ventricular pacing, sick sinus syndrome, heart failure hospitalization, atrial fibrillation, DDD pacing, QRS duration, pacemaker therapy
MeSH terms: Aged, Aged, 80 and over, Atrial Fibrillation, Bradycardia, Cardiac Pacing, Artificial, Electrocardiography, Female, Follow-Up Studies, Heart Failure, Hospitalization, Humans, Male, Sick Sinus Syndrome, Proportional Hazards Models, Survival Analysis, Randomized Controlled Trials as Topic, Risk Assessment

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Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction

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