Closed loop stimulation reduces the incidence of atrial high-rate episodes compared with conventional rate-adaptive pacing in patients with sinus node dysfunctions

E. C. L. Pisano, V. Calvi, Maria Rosa Viscusi, A. Rapacciuolo, L. Lazzari, L. Bontempi, Gemma Pelargonio, G. Arena, V. Caccavo, C. -C. Wang, B. Merkely, L. -Y. Lin, O. Il-Young, E. Bertaglia, D. Saporito, Maurizio Menichelli, A. Nicosia, D. M. Carretta, A. Coppolino, C. K. ChingA. M. del Castillo, X. Su, M. D. Maestro, D. Giacopelli, A. Gargaro, G. L. Botto

Risultato della ricerca: Contributo in rivistaArticolo in rivista

Abstract

Aims Subclinical atrial fibrillation (AF) is associated with increased risk of progression to clinical AF, stroke, and cardiovascular death. We hypothesized that in pacemaker patients requiring dual-chamber rate-adaptive (DDDR) pacing, closed loop stimulation (CLS) integrated into the circulatory control system through intra-cardiac impedance monitoring would reduce the occurrence of atrial high-rate episodes (AHREs) compared with conventional DDDR pacing. Methods Patients with sinus node dysfunctions (SNDs) and an implanted pacemaker or defibrillator were randomly allocated to dual- and results chamber CLS (n = 612) or accelerometer-based DDDR pacing (n = 598) and followed for 3 years. The primary endpoint was time to the composite endpoint of the first AHRE lasting ≥6 min, stroke, or transient ischaemic attack (TIA). All AHREs were independently adjudicated using intra-cardiac electrograms. The incidence of the primary endpoint was lower in the CLS arm (50.6%) than in the DDDR arm (55.7%), primarily due to the reduction in AHREs lasting between 6 h and 7 days. Unadjusted site-stratified hazard ratio (HR) for CLS vs. DDDR was 0.84 [95% confidence interval (CI), 0.72–0.99; P = 0.035]. After adjusting for CHA2DS2-VASc score, the HR remained 0.84 (95% CI, 0.71–0.99; P = 0.033). In subgroup analyses of AHRE incidence, the incremental benefit of CLS was greatest in patients without atrioventricular block (HR, 0.77; P = 0.008) and in patients without AF history (HR, 0.73; P = 0.009). The contribution of stroke/TIA to the primary endpoint (1.3%) was low and not statistically different between study arms. Conclusion Dual-chamber CLS in patients with SND is associated with a significantly lower AHRE incidence than conventional DDDR pacing.
Lingua originaleEnglish
pagine (da-a)N/A-N/A
RivistaEuropace
Volume26
DOI
Stato di pubblicazionePubblicato - 2024

Keywords

  • Accelerometer pacemaker sensor
  • Atrial fibrillation
  • Stroke
  • Closed loop stimulation
  • Rate-adaptive pacing
  • Atrial high-rate episodes

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