title: Atrial-based pacing has no benefit over ventricular pacing in preventing atrial arrhythmias in adults with congenital heart disease.
abstract: OBJECTIVE
  To determine whether atrial-based pacing prevents atrial arrhythmias in adults with congenital heart disease (CHD) compared with ventricular pacing.
  
  
  RESULTS
  All adult CHD patients from four participating centres with a permanent pacemaker were identified. Patients with permanent atrial arrhythmias at pacemaker implantation and patients who received a pacemaker for treatment of drug-refractory atrial arrhythmias were excluded. The final study population consisted of 211 patients (52% male, 36% complex CHD) who received a first pacemaker for sick sinus dysfunction (n = 82) or atrioventricular block (n = 129) at a median age of 24 years [interquartile range (IQR), 12-34]. A history of atrial arrhythmias at implantation was present in 49 patients (23%). Atrial-based pacing was the initial pacing mode in 139 patients (66%) while the others (34%) received ventricular pacing. During a median follow-up of 13 years (IQR, 7-21), 90 patients (43%) developed an atrial arrhythmia. Multivariate analysis demonstrated no significant effect of atrial-based pacing on subsequent atrial arrhythmias [hazard ratio (HR), 1.53; 95% confidence interval (CI), 0.91-2.56; P = 0.1]. Independent predictors of atrial arrhythmia were history of atrial arrhythmias (HR, 5.55; 95% CI, 3.47-8.89; P< 0.0001), older age (≥18 years) at pacemaker implantation (HR, 2.29; 95% CI, 1.29-4.04; P = 0.005), and complex CHD (HR, 1.57; 95% CI, 1.01-2.45; P = 0.04).
  
  
  CONCLUSIONS
  In contrast to the general population, atrial-based pacing was not associated with a lower incidence of atrial arrhythmia in adults with CHD.
authors.affiliation: Department of Cardiology, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
authors.forename: Petra
authors.initials: P
authors.lastname: Opic
authors.forename: Sing-Chien
authors.initials: SC
authors.lastname: Yap
authors.forename: Matthijs
authors.initials: M
authors.lastname: Van Kranenburg
authors.forename: Arie P
authors.initials: AP
authors.lastname: Van Dijk
authors.forename: Werner
authors.initials: W
authors.lastname: Budts
authors.forename: Hubert W
authors.initials: HW
authors.lastname: Vliegen
authors.forename: Lieselot
authors.initials: L
authors.lastname: Van Erven
authors.forename: Anil
authors.initials: A
authors.lastname: Can
authors.forename: Gulhan
authors.initials: G
authors.lastname: Sahin
authors.forename: Natasja Ms
authors.initials: NM
authors.lastname: De Groot
authors.forename: Maarten
authors.initials: M
authors.lastname: Witsenburg
authors.forename: Jolien W
authors.initials: JW
authors.lastname: Roos-Hesselink
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D016275:Atrial Function; D001530:Belgium; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000379:methods*; D016009:Chi-Square Distribution; D002648:Child; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D016276:Ventricular Function; D055815:Young Adult
keywords: Arrhythmia; Atrial fibrillation; Pacing; Tetralogy of Fallot; Transposition of the Great Vessels