title: The OPTI-MIND study: a prospective, observational study of pacemaker patients according to pacing modality and primary indications.
abstract: OBJECTIVE
  The OPTI-MIND study aims to collect 2-year clinical outcomes of pacemaker patients in real-world clinical practice, overall and according to patient characteristics and pacemaker settings.
  
  
  RESULTS
  The present analysis of the OPTI-MIND study describes the programmed device settings after discharge from the pacemaker implant. The objective was to determine whether these settings fit recent guidelines for device-programmed physiological pacing based on the preservation of atrioventricular synchrony, avoiding unnecessary pacing, ensuring rate increase during exercise or preventing neurally mediated symptoms. A total of 1740 patients were enroled at 68 centres worldwide. Baseline patient characteristics and device programming settings are available in 1674 of 1740 patients (96%). Guidelines to ensure physiological pacing were followed in 41% of patients: in patients with sinus node disease (SND), and without atrioventricular block (AVB), device programming could have led to unnecessary right ventricular pacing in 38% of patients. In SND patients with chronotropic incompetence, assisted rate increase during exercise was not programmed in 42% of patients. In 11% of patients with AVB, atrioventricular (AV) synchrony was not pursued; the main drivers being advanced age and history of atrial fibrillation. Patients with both SND and AVB were generally programmed physiologically (87%).
  
  
  CONCLUSIONS
  The present analysis showed that frequent deviations occurred when comparing the device settings at discharge from the pacemaker implant in clinical practice to the available guidelines on pacing mode selection. Analysis of 2-year outcomes in the OPTI-MIND study will provide an insight into whether specific physiological settings could improve the quality of pacing with a positive effect on patient outcome.
authors: Institute of Cardiology, University of Bologna, Bologna 40138, Italy.
authors: Mauro
authors: M
authors: Biffi
authors: Donato
authors: D
authors: Melissano
authors: Paolo
authors: P
authors: Rossi
authors: Gabriela
authors: G
authors: Kaliska
authors: Aleš
authors: A
authors: Havliĉek
authors: Gemma
authors: G
authors: Pelargonio
authors: Rafael
authors: R
authors: Romero
authors: Ciro
authors: C
authors: Guastaferro
authors: Maurizio
authors: M
authors: Menichelli
authors: Elisa
authors: E
authors: Vireca
authors: Jessica
authors: J
authors: Frisoni
authors: Giuseppe
authors: G
authors: Boriani
authors: Tibor
authors: T
authors: Malacky
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000628:therapy*; D054537:Atrioventricular Block / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000379:methods* / Q000592:standards; D015331:Cohort Studies; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012804:Sick Sinus Syndrome / Q000628:therapy*; D016896:Treatment Outcome
keywords: Bradyarrhythmia; Cardiac pacing; Pacemaker; Reprogramming