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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
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, 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]
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Metadata
- 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
- Venue
- Circulation
- Published
- 2003-06-17
- Volume
- 107
- Issue
- 23
- Pages
- 2932-2937
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- 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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