Document Detail

The mode selection trial (MOST) in sinus node dysfunction: design, rationale, and baseline characteristics of the first 1000 patients.
MedLine Citation:
PMID:  11011325     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: More than 200,000 permanent pacemakers will be implanted in the United States in 2000 at a cost of more than $2 billion. Sick sinus syndrome (SSS) will likely account for approximately half of all cases necessitating implantation. Pacemaker technology permits the selection of ventricular (single-chamber) or dual-chamber devices. However, clinical and outcomes data are inadequate to support a clear recommendation that one or the other type of device be used. METHODS: The Mode Selection Trial (MOST) is a single-blind study supported by the National Heart, Lung, and Blood Institute designed to enroll 2000 patients with SSS. All patients will receive a DDDR pacemaker programmed to VVIR or DDDR before implantation. The average time of follow-up will be 3 years. MOST has a >90% power to detect a 25% reduction in the primary end point-nonfatal stroke or total (all cause) mortality-in the DDDR-treated group. Secondary end points will include health-related quality of life and cost effectiveness, atrial fibrillation, and development of pacemaker syndrome. Prespecified subgroups for analysis will include women and the elderly. Enrollment was completed in October 1999, with a total of 2010 patients. RESULTS: The median age of the first 1000 enrolled patients is 74 years, with 25% of patients 80 years or older. Women comprise 49%, and 17% are nonwhite, predominantly black (13%). Before pacemaker implantation, 22% of patients reported a history of congestive heart failure, 11% coronary angioplasty, and 25% coronary bypass surgery. Supraventricular tachycardia including atrial fibrillation was present in 53% of patients. A prior stroke was reported by 12%. Antiarrhythmic therapy was in use in 18% of patients. CONCLUSIONS: MOST will fill the clinical need for carefully designed prospective studies to define the benefits of dual-chamber versus single-chamber ventricular pacing in patients with SSS. The MOST population is typical of the overall pacemaker population in the United States. Thus the final results of MOST should be clinically generalizable.
G A Lamas; K Lee; M Sweeney; A Leon; R Yee; K Ellenbogen; S Greer; D Wilber; R Silverman; R Marinchak; R Bernstein; R S Mittleman; E H Lieberman; C Sullivan; L Zorn; G Flaker; E Schron; E J Orav; L Goldman
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial    
Journal Detail:
Title:  American heart journal     Volume:  140     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2000 Oct 
Date Detail:
Created Date:  2000-10-18     Completed Date:  2000-11-02     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  541-51     Citation Subset:  AIM; IM    
Division of Cardiology, Mount Sinai Medical Center, and the University of Miami School of Medicine, Miami Beach, USA.
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MeSH Terms
Aged, 80 and over
Cardiac Pacing, Artificial* / economics,  mortality
Cost-Benefit Analysis
Prospective Studies
Quality of Life
Sick Sinus Syndrome / economics,  mortality,  therapy*
Single-Blind Method
Survival Rate
United States / epidemiology

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

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