Document Detail

Relationship between pacemaker dependency and the effect of pacing mode on cardiovascular outcomes.
MedLine Citation:
PMID:  11425772     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: A recently completed trial, the Canadian Trial of Physiological Pacing (CTOPP), showed that physiological pacing did not significantly reduce mortality, stroke, or heart failure hospitalization, but it did show that atrial fibrillation occurred less frequently in patients with physiological pacing. Many pacemaker patients experience only transient bradyarrhythmias with an adequate unpaced heart rate (UHR) and are not pacemaker-dependent. The purpose of the present analysis was to determine if pacemaker-dependent patients have an increased benefit from physiological pacing compared with non-pacemaker-dependent patients. METHODS AND RESULTS: Of 2568 patients included in the CTOPP trial, 2244 patients had a pacemaker dependency test performed at the first follow-up visit. The yearly event rate of cardiovascular death or stroke steadily increased with decreasing UHR in the ventricular pacing group, but it remained constant in the physiological pacing group. When the patients were subdivided to UHR </=60 bpm or >60 bpm, there was an interaction between pacing mode treatment and UHR subgroup. The Kaplan-Meier plot confirmed a physiological pacing advantage only in the UHR </=60 bpm subgroup. This differential effect was also present for the outcomes of cardiovascular death and total mortality. CONCLUSIONS: This study demonstrated that UHR at first follow-up has an important influence on how pacing mode selection affects cardiovascular death and total mortality. Pacemaker-dependent patients with low UHR will probably be paced frequently and will likely benefit from physiological pacing. In contrast, non-pacemaker-dependent patients will likely be paced infrequently and may not benefit from physiological pacing.
A S Tang; R S Roberts; C Kerr; A M Gillis; M S Green; M Talajic; S Yusuf; H Abdollah; M Gent; S J Connolly
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Circulation     Volume:  103     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2001 Jun 
Date Detail:
Created Date:  2001-06-26     Completed Date:  2001-08-09     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3081-5     Citation Subset:  AIM; IM    
University of Ottawa Heart Institute, Ottawa, Ontario.
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MeSH Terms
Aged, 80 and over
Bradycardia / complications,  therapy*
Cardiac Pacing, Artificial / methods*
Cardiovascular Diseases / etiology,  mortality
Follow-Up Studies
Middle Aged
Pacemaker, Artificial
Randomized Controlled Trials as Topic
Risk Factors
Stroke / etiology
Survival Analysis

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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