Physiologic pacing for atrial fibrillation prevention in sinus node disease: long-term results.
BACKGROUND
Physiologic pacing has been demonstrated to be effective in preventing atrial fibrillation recurrences in patients with sinus bradycardia. Aim of the study was to evaluate long-term incidence of atrial fibrillation in a large population of patients affected by sinus node disease receiving physiologic pacing. Furthermore, predictors of arrhythmia recurrence and effect of pacing mode were investigated.


METHODS
Four hundred twenty-five patients (220 Male, 77 +/- 9 years) were retrospectively analyzed: implanted system was AAI in 20.5% and DDD in 79.5%. Thirty-four percent had atrial fibrillation before implant.


RESULTS
Follow-up lasted on average 51 +/- 36 months (median 42, range 1 month-18 years). Sixty-six percent were on antiarrhythmic drug therapy. After 5 years, 89% survived, 74.5% had at least one episode of atrial fibrillation, 39.9% were submitted to electrical cardioversion, 67.2% were hospitalized because of cardiac causes, 33.3% developed permanent atrial fibrillation. Primary conduction system disease and valvular heart disease were independent predictors for atrial fibrillation recurrence. Preimplant atrial fibrillation predicted arrhythmia recurrence during the follow-up, but it did not predict development of permanent atrial fibrillation. AAI pacing, when compared with DDD, was associated to a lower rate of atrial fibrillation recurrences (AAI 28.7%, DDD 53.3%, P < 0.001).


CONCLUSIONS
In spite of expected benefits of physiologic pacing, the development of atrial fibrillation and permanent atrial fibrillation were quite common. The additional benefits of multifunction pacemakers designed to prevent and treat atrial fibrillation should be evaluated in controlled studies.
Ricci
Renato
R
Department of Cardiology, S. Filippo Neri Hospital, Via Martinotti, 20-00135 Rome, Italy. renatopietroricci@tin.it
Pignalberi
Carlo
C
Santini
Luca
L
Magris
Barbara
B
Russo
Maurizio
M
Grovale
Nicoletta
N
de Santo
Tiziana
T
Santini
Massimo
M
D000368:Aged; D001146:Arrhythmia, Sinus / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D002304:Cardiac Pacing, Artificial / Q000706:statistics & numerical data*; D015897:Comorbidity; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D055502:Secondary Prevention