title: Heart failure in patients with sick sinus syndrome treated with single lead atrial or dual-chamber pacing: no association with pacing mode or right ventricular pacing site.
abstract: OBJECTIVE
  Previous studies indicate that ventricular pacing may precipitate heart failure (HF). We investigated occurrence of HF during long-term follow-up among patients with sick sinus syndrome (SSS) randomized to AAIR or DDDR pacing. Furthermore, we investigated effects of percentage of ventricular pacing (%VP) and pacing site in the ventricle.
  
  
  RESULTS
  We analysed data from 1415 patients randomized to AAIR (n = 707) or DDDR pacing (n = 708). Ventricular pacing leads were recorded as located in either an apical or a non-apical position. The %VP and HF hospitalizations were recorded during follow-up. Patients were classified with new HF, if in New York Heart Association (NYHA) functional class IV or if presence of ≥2 of: oedema; dyspnoea; NYHA functional class III. Mean follow-up was 5.4 ± 2.4 years. Heart failure hospitalizations did not differ between groups. In the AAIR group, 170 of the 707 (26%) patients developed HF vs. 169 of the 708 (26%) patients in the DDDR group, hazard rate ratio (HR) 1.00, 95% confidence interval (CI) 0.79-1.22, P = 0.87. In DDDR patients, 146 of the 512 patients (29%) with ventricular leads in an apical position developed HF vs. 28 of the 161 patients (17%) with the leads in a non-apical position, HR 0.67, CI 0.45-1.00, P = 0.05. After adjustments this difference was non-significant. The incidence of HF was not associated with %VP (P = 0.57).
  
  
  CONCLUSIONS
  In patients with SSS, HF was not associated with pacing mode, %VP, or ventricular lead localization. This suggests that DDDR pacing is safe in patients with SSS without precipitating HF.
authors.affiliation: Department of Cardiology,  Aalborg Hospital,  Aalborg University Hospital, Hobrovej 16-18, Postbox 365, DK-9100 Aalborg,  Denmark.
authors.forename: Sam
authors.initials: S
authors.lastname: Riahi
authors.forename: Jens Cosedis
authors.initials: JC
authors.lastname: Nielsen
authors.forename: Søren
authors.initials: S
authors.lastname: Hjortshøj
authors.forename: Poul Erik B
authors.initials: PE
authors.lastname: Thomsen
authors.forename: Søren
authors.initials: S
authors.lastname: Højberg
authors.forename: Mogens
authors.initials: M
authors.lastname: Møller
authors.forename: Dorthe
authors.initials: D
authors.lastname: Dalsgaard
authors.forename: Tonny
authors.initials: T
authors.lastname: Nielsen
authors.forename: Mogens
authors.initials: M
authors.lastname: Asklund
authors.forename: Elsebeth V
authors.initials: EV
authors.lastname: Friis
authors.forename: Per D
authors.initials: PD
authors.lastname: Christensen
authors.forename: Erik H
authors.initials: EH
authors.lastname: Simonsen
authors.forename: Ulrik H
authors.initials: UH
authors.lastname: Eriksen
authors.forename: Gunnar V H
authors.initials: GV
authors.lastname: Jensen
authors.forename: Jesper H
authors.initials: JH
authors.lastname: Svendsen
authors.forename: William D
authors.initials: WD
authors.lastname: Toff
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Healey
authors.forename: Henning R
authors.initials: HR
authors.lastname: Andersen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects* / Q000379:methods*; D004417:Dyspnea / Q000175:diagnosis; D004487:Edema / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D012804:Sick Sinus Syndrome / Q000628:therapy*; D016896:Treatment Outcome