Document Detail

The role of pacing modality in determining long-term survival in the sick sinus syndrome.
MedLine Citation:
PMID:  8338288     Owner:  NLM     Status:  MEDLINE    
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.
E B Sgarbossa; S L Pinski; J D Maloney
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of internal medicine     Volume:  119     ISSN:  0003-4819     ISO Abbreviation:  Ann. Intern. Med.     Publication Date:  1993 Sep 
Date Detail:
Created Date:  1993-08-26     Completed Date:  1993-08-26     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0372351     Medline TA:  Ann Intern Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  359-65     Citation Subset:  AIM; IM    
Department of Cardiology, Cleveland Clinic Foundation, OH 44195.
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MeSH Terms
Analysis of Variance
Cardiac Pacing, Artificial / methods*
Follow-Up Studies
Proportional Hazards Models
Retrospective Studies
Sick Sinus Syndrome / mortality*,  therapy*
Survival Analysis
Treatment Outcome

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