title: Cardiac pacing strategies and post-implantation risk of atrial fibrillation and heart failure events in sinus node dysfunction patients: a collaborative analysis of over 6000 patients.
abstract: BACKGROUND
  Pacing-modes selection in sinus-node-dysfunction (SND) patients continues to be a subject of debate. Atrial fibrillation (AF) and cardiac dysfunction remain significant problems following cardiac-pacing therapy. Prevention of these complications is of clinical relevance.
  
  
  METHODS
  We performed a collaborative pooled-analysis of randomized trials (RCT) to evaluate the effect of currently available pacing strategies on the risk of post-implantation AF and heart failure events (HF) in SND patients. The primary endpoint was a composite AF and HF events.
  
  
  RESULTS
  Ten RCTs (n = 6639, male 57 %, median follow-up 2.5 years) were included. The pooled-analysis was stratified into two subsets [single chamber atrial pacing (AAI) vs. dual chamber pacing (DDD), and minimal ventricular pacing (MinVP) vs. DDD]. No significant difference was observed in the AAI vs. DDD subset regarding the primary outcome (P = 0.83). Notably, the mean percentage of ventricular-pacing in the MinVP group was 6.5 vs. 77.4 % in the DDD group (P < 0.05), and MinVP was associated with a substantially reduced risk of composite AF and HF (OR 0.66, P = 0.007) in patients receiving pacemaker as primary treatment. However, in the long-term paced patients scheduled for device replacement, there was no significant difference in the rate of primary endpoint between MinVP vs. DDD groups (P > 0.05).
  
  
  CONCLUSIONS
  These results support MinVP over conventional DDD for SND patients who received pacemaker as primary treatment in improving the clinical outcome. For patients who already had chronic ventricular-pacing and impaired cardiac function, a device update to MinVP algorithm may exert no favorable effect on the cardiac performance.
authors.affiliation: Fellowship EHRA/ESC & APHRS; Department of Cardiology, Shanghai General Hospital/Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. drsjchen@126.com.|Fellowship EHRA/ESC, EHRA/ESC Academic Teaching Center, Department of Cardiology, Elisabethinen University Teaching Hospital Linz, Linz, Austria. drsjchen@126.com.
authors.forename: Shaojie
authors.initials: S
authors.lastname: Chen
authors.affiliation: Department of Cardiology, Affiliated Hospital of Zunyi Medical College, Zunyi, China.
authors.forename: Zhenglong
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Hospital Regional Darcy Vargas, Rio Bonito, Rio de Janeiro, Brazil.|Department of Medicine, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil.
authors.forename: Marcio Galindo
authors.initials: MG
authors.lastname: Kiuchi
authors.affiliation: Sul Fluminense University Hospital, Vassouras, Brazil.
authors.forename: Bruno Rustum
authors.initials: BR
authors.lastname: Andrea
authors.affiliation: Duke Clinical Research Institute/Duke University Medical Center, Durham, NC, USA.
authors.forename: Mitchell W
authors.initials: MW
authors.lastname: Krucoff
authors.affiliation: Department of Cardiology, Shanghai General Hospital/Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Shaowen
authors.initials: S
authors.lastname: Liu
authors.affiliation: European Heart Rhythm Association/European Society of Cardiology, Academic Teaching Center, Department of Cardiology, Elisabethinen University Teaching Hospital Linz, Linz, Austria.
authors.forename: Helmut
authors.initials: H
authors.lastname: Pürerfellner
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000379:methods*; D016009:Chi-Square Distribution; D004867:Equipment Design; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D016017:Odds Ratio; D010138:Pacemaker, Artificial; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D012804:Sick Sinus Syndrome / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Atrial fibrillation; Cardiac pacing; Heart failure; Outcome; Randomized trials; Sinus node dysfunction