title: Prospective randomized study to assess the efficacy of site and rate of atrial pacing on long-term progression of atrial fibrillation in sick sinus syndrome: Septal Pacing for Atrial Fibrillation Suppression Evaluation (SAFE) Study.
abstract: BACKGROUND
  Atrial-based pacing is associated with lower risk of atrial fibrillation (AF) in sick sinus syndrome compared with ventricular pacing; nevertheless, the impact of site and rate of atrial pacing on progression of AF remains unclear. We evaluated whether long-term atrial pacing at the right atrial (RA) appendage versus the low RA septum with (ON) or without (OFF) a continuous atrial overdrive pacing algorithm can prevent the development of persistent AF.
  
  
  RESULTS
  We randomized 385 patients with paroxysmal AF and sick sinus syndrome in whom a pacemaker was indicated to pacing at RA appendage ON (n=98), RA appendage OFF (n=99), RA septum ON (n=92), or RA septum OFF (n=96). The primary outcome was the occurrence of persistent AF (AF documented at least 7 days apart or need for cardioversion). Demographic data were homogeneous across both pacing site (RA appendage/RA septum) and atrial overdrive pacing (ON/OFF). After a mean follow-up of 3.1 years, persistent AF occurred in 99 patients (25.8%; annual rate of persistent AF, 8.3%). Alternative site pacing at the RA septum versus conventional RA appendage (hazard ratio=1.18; 95% confidence interval, 0.79-1.75; P=0.65) or continuous atrial overdrive pacing ON versus OFF (hazard ratio=1.17; 95% confidence interval, 0.79-1.74; P=0.69) did not prevent the development of persistent AF.
  
  
  CONCLUSIONS
  In patients with paroxysmal AF and sick sinus syndrome requiring pacemaker implantation, an alternative atrial pacing site at the RA septum or continuous atrial overdrive pacing did not prevent the development of persistent AF.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. UNIQUE IDENTIFIER: NCT00419640.
authors.affiliation: Cardiology Division, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China.
authors.forename: Chu-Pak
authors.initials: CP
authors.lastname: Lau
authors.forename: Ngarmukos
authors.initials: N
authors.lastname: Tachapong
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Wang
authors.forename: Jing-Feng
authors.initials: JF
authors.lastname: Wang
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Abe
authors.forename: Chi-Woon
authors.initials: CW
authors.lastname: Kong
authors.forename: Reginald
authors.initials: R
authors.lastname: Liew
authors.forename: Dong-Gu
authors.initials: DG
authors.lastname: Shin
authors.forename: Luigi
authors.initials: L
authors.lastname: Padeletti
authors.forename: You-Ho
authors.initials: YH
authors.lastname: Kim
authors.forename: Razali
authors.initials: R
authors.lastname: Omar
authors.forename: Kreingkrai
authors.initials: K
authors.lastname: Jirarojanakorn
authors.forename: Yoon-Nyun
authors.initials: YN
authors.lastname: Kim
authors.forename: Mien-Cheng
authors.initials: MC
authors.lastname: Chen
authors.forename: Charn
authors.initials: C
authors.lastname: Sriratanasathavorn
authors.forename: Muhammad
authors.initials: M
authors.lastname: Munawar
authors.forename: Ruth
authors.initials: R
authors.lastname: Kam
authors.forename: Jan-Yow
authors.initials: JY
authors.lastname: Chen
authors.forename: Yong-Keun
authors.initials: YK
authors.lastname: Cho
authors.forename: Yi-Gang
authors.initials: YG
authors.lastname: Li
authors.forename: Shu-Lin
authors.initials: SL
authors.lastname: Wu
authors.forename: Christophe
authors.initials: C
authors.lastname: Bailleul
authors.forename: Hung-Fat
authors.initials: HF
authors.lastname: Tse
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D020517:Atrial Appendage; D001281:Atrial Fibrillation / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002318:Cardiovascular Diseases / Q000401:mortality; D018450:Disease Progression; D004554:Electric Countershock; D005260:Female; D006346:Heart Septum; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011446:Prospective Studies; D012804:Sick Sinus Syndrome / Q000150:complications* / Q000628:therapy; D020521:Stroke / Q000209:etiology; D017211:Treatment Failure
keywords: atrial fibrillation; cardiac pacing, artificial; sick sinus syndrome