title: Antiarrhythmic benefits of dual chamber stimulation with rate-response in patients with paroxysmal atrial fibrillation and chronotropic incompetence: a prospective, multicentre study.
abstract: BACKGROUND
  While the haemodynamic benefits of DDDR pacing compared with DDD pacing in patients with brady-tachy syndrome and chronotropic incompetence (CI) are well demonstrated, the antiarrhythmic advantage is controversial and so far not clearly demonstrated.
  
  
  OBJECTIVE
  We have performed a prospective, randomized, multicentre study to evaluate the efficacy of DDDR and DDD pacing modes in preventing paroxysmal atrial fibrillation (PAF) episodes in patients with brady-tachy syndrome and CI.
  
  
  RESULTS
  Seventy-eight patients were included in the study. All patients had a dual chamber pacemaker implanted and were randomly programmed to DDD or DDDR with a cross over (DDD --> DDDR or vice versa) at 3 months. The final evaluation was performed at 6 months by means of two self-administered symptom questionnaires to evaluate activity. Symptoms of palpitations were analysed and scored. The patients were less symptomatic with the DDDR mode. The number of mode-switch activations compared with symptomatic episodes of PAF confirmed the high rate of asymptomatic PAF episodes in patients with brady-tachy syndrome. We conclude that in a small but well defined population of patients affected by sick sinus syndrome with CI and severely symptomatic PAF, DDDR pacing compared with DDD pacing may offer an additional antiarrhythmic benefit and should be considered the primary mode of pacing.
authors.affiliation: Clinica Villa Tiberia, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Bellocci
authors.forename: A
authors.initials: A
authors.lastname: Spampinato
authors.forename: R
authors.initials: R
authors.lastname: Ricci
authors.forename: A
authors.initials: A
authors.lastname: Puglisi
authors.forename: A
authors.initials: A
authors.lastname: Capucci
authors.forename: P
authors.initials: P
authors.lastname: Dini
authors.forename: G
authors.initials: G
authors.lastname: Boriani
authors.forename: G
authors.initials: G
authors.lastname: Botto
authors.forename: A
authors.initials: A
authors.lastname: Curnis
authors.forename: P V
authors.initials: PV
authors.lastname: Moracchini
authors.forename: G
authors.initials: G
authors.lastname: Nicotra
authors.forename: F
authors.initials: F
authors.lastname: Lisi
authors.forename: P
authors.initials: P
authors.lastname: Nigro
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000517:prevention & control*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012804:Sick Sinus Syndrome / Q000628:therapy*