| High incidence of pacemaker syndrome in patients with sinus node dysfunction treated with ventricular-based pacing in the Mode Selection Trial (MOST). | |
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MedLine Citation:
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PMID: 15172414 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: We evaluated the incidence, predictors, and treatment of pacemaker syndrome in patients with sinus node dysfunction treated with ventricular-based (VVIR) pacing in the Mode Selection Trial (MOST). BACKGROUND: Pacemaker syndrome, or intolerance to VVIR pacing, consists of cardiovascular signs and symptoms induced by VVIR pacing. METHODS: The definition of pacemaker syndrome required that a patient with single-chamber VVIR pacing develop either congestive signs and symptoms associated with retrograde conduction during VVIR pacing or a >or=20 mm Hg reduction of systolic blood pressure during VVIR pacing, associated with reproducible symptoms of weakness, lightheadedness, or syncope. RESULTS: Of 996 patients randomized to VVIR pacing, 182 (18.3%) met criteria for pacemaker syndrome in follow-up. Pacemaker syndrome occurred early in most patients (13.8% at 6 months, 16.0% at 1 year, increasing to 19.7% at 4 years). Baseline univariate predictors of pacemaker syndrome included a lower sinus rate and higher programmed pacemaker rate. Previous heart failure, ejection fraction, and drop in systolic blood pressure with VVIR pacing at implantation did not predict the development of pacemaker syndrome. Post-implantation predictors of pacemaker syndrome were a higher percentage of paced beats, higher programmed low rate, and slower underlying spontaneous sinus rate. Quality of life decreased at the time of diagnosis of pacemaker syndrome and improved with reprogramming to atrial-based pacing. CONCLUSIONS: Severe pacemaker syndrome developed in nearly 20% of VVIR-paced patients and improved with reprogramming to the dual-chamber pacing mode. Because prediction of pacemaker syndrome is difficult, the only way to prevent pacemaker syndrome is to implant atrial-based pacemakers in all patients. |
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Authors:
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Mark S Link; Anne S Hellkamp; N A Mark Estes; E John Orav; Kenneth A Ellenbogen; Bassiema Ibrahim; Arnold Greenspon; Carlos Rizo-Patron; Lee Goldman; Kerry L Lee; Gervasio A Lamas; |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 43 ISSN: 0735-1097 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 2004 Jun |
Date Detail:
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Created Date: 2004-06-02 Completed Date: 2004-06-17 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 2066-71 Citation Subset: AIM; IM |
Affiliation:
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Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02111, USA. MLink@tufts-nemc.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Cardiac Pacing, Artificial / adverse effects* Female Follow-Up Studies Humans Incidence Male Randomized Controlled Trials as Topic Sick Sinus Syndrome / therapy* Syncope / etiology* Syndrome Treatment Outcome |
| Grant Support | |
ID/Acronym/Agency:
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U01 HL 49804/HL/NHLBI NIH HHS; U01 HL 53973/HL/NHLBI NIH HHS; U01 HL 55981/HL/NHLBI NIH HHS |
| Comments/Corrections | |
Comment In:
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J Am Coll Cardiol. 2004 Jun 2;43(11):2072-4
[PMID:
15172415
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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