| The role of pacing modality in determining long-term survival in the sick sinus syndrome. | |
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MedLine Citation:
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PMID: 8338288 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To determine whether the atrial-based pacing modalities ("physiologic pacing") improve survival when compared with single-chamber ventricular pacing in patients with the sick sinus syndrome. DESIGN: Retrospective, nonrandomized study. SETTING: A tertiary care teaching hospital. PATIENTS: A total of 507 patients with a mean age of 66 years who received an initial pacemaker for the sick sinus syndrome between January 1980 and December 1989. Pacing modes were ventricular (22%), atrial (4%), and dual-chamber (74%). MEASUREMENTS: Total and cardiovascular mortality rates. Mean follow-up was 66 months. RESULTS: Independent predictors of total mortality by the Cox proportional hazards model were 1) New York Heart Association functional class (hazard ratio = 1.67/class; 95% Cl, 1.31 to 2.11); 2) age (hazard ratio = 1.62/12-year increment; Cl, 1.28 to 2.05); 3) peripheral vascular disease (hazard ratio = 2.21; Cl, 1.42 to 3.42); 4) bundle branch block (hazard ratio = 2.04; Cl, 1.33 to 3.13); 5) coronary artery disease (hazard ratio = 1.66; Cl, 1.15 to 2.39); and 6) valvular heart disease (hazard ratio = 1.71; Cl, 1.08 to 2.69). The same variables were independent predictors of cardiovascular mortality, with cerebrovascular disease reaching borderline statistical significance (hazard ratio = 1.69; Cl, 1.00 to 2.86). Using univariate analysis, single-chamber ventricular pacing had more than 40% increased risk for both total and cardiovascular death, but the difference was of borderline statistical significance (total mortality: P = 0.053; hazard ratio = 1.43; Cl, 0.99 to 2.07; cardiovascular mortality: P = 0.15; hazard ratio = 1.41; Cl = 0.87 to 2.29). CONCLUSIONS: Because the role of the ventricular pacing mode as a long-term predictor of total and cardiovascular mortality remains inconclusive, a large, randomized study is necessary to confirm whether physiologic pacing provides a substantial reduction in mortality when compared with ventricular pacing. |
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Authors:
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E B Sgarbossa; S L Pinski; J D Maloney |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Annals of internal medicine Volume: 119 ISSN: 0003-4819 ISO Abbreviation: Ann. Intern. Med. Publication Date: 1993 Sep |
Date Detail:
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Created Date: 1993-08-26 Completed Date: 1993-08-26 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0372351 Medline TA: Ann Intern Med Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 359-65 Citation Subset: AIM; IM |
Affiliation:
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Department of Cardiology, Cleveland Clinic Foundation, OH 44195. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Analysis of Variance Cardiac Pacing, Artificial / methods* Echocardiography Female Follow-Up Studies Humans Male Proportional Hazards Models Retrospective Studies Sick Sinus Syndrome / mortality*, therapy* Survival Analysis Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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