Single-chamber versus dual-chamber pacing for high-grade atrioventricular block
Single-chamber versus dual-chamber pacing for high-grade atrioventricular block
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DOI：
10.1056/nejmoa042283
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发表时间：
2005-07-14
影响因子：
158.5
通讯作者：
Skehan, JD
中科院分区：
文献类型：
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作者：
Toff, WD;Camm, J;Skehan, JD
背景在房室传导阻滞的治疗中，双腔心脏起搏被认为比单腔心室起搏具有临床获益，但支持证据主要来自回顾性研究。关于双腔起搏的真正益处仍然存在不确定性，特别是在老年人中，其使用频率低于年轻患者。2021例因高度房室传导阻滞而首次植入起搏器的70岁或以上患者被随机分配接受单腔心室起搏器（1009例患者）或双腔起搏器（1012例患者）。在单腔组中，患者被随机分配接受固定频率起搏（504例患者）或频率自适应起搏（505例患者）。主要结局为全因死亡。次要结局包括房颤、心力衰竭、卒中、短暂性脑缺血发作或其他血栓栓塞的复合事件。随访期间死亡率的中位数为4.6年，其他心血管事件的中位数为3年。单腔组的平均年死亡率为7.2%，双腔组为7.4%（风险比为0.96; 95%置信区间为0.83 ~ 1.11）。我们发现单腔起搏组和双腔起搏组在房颤、心力衰竭或中风、短暂性脑缺血发作或其他血栓栓塞的复合发生率方面无显著差异。起搏模式不影响前五年内所有原因的死亡率或前三年内心血管事件的发生率在植入起搏器后
BACKGROUNDIn the treatment of atrioventricular block, dual-chamber cardiac pacing is thought to confer a clinical benefit as compared with single-chamber ventricular pacing, but the supporting evidence is mainly from retrospective studies. Uncertainty persists regarding the true benefits of dual-chamber pacing, particularly in the elderly, in whom it is used less often than in younger patients.METHODSIn a multicenter, randomized, parallel-group trial, 2021 patients 70 years of age or older who were undergoing their first pacemaker implant for high-grade atrioventricular block were randomly assigned to receive a single-chamber ventricular pacemaker ( 1009 patients) or a dual-chamber pacemaker ( 1012 patients). In the single-chamber group, patients were randomly assigned to receive either fixed-rate pacing ( 504 patients) or rate-adaptive pacing ( 505 patients). The primary outcome was death from all causes. Secondary outcomes included atrial fibrillation, heart failure, and a composite of stroke, transient ischemic attack, or other thromboembolism.RESULTSThe median follow-up period was 4.6 years for mortality and 3 years for other cardiovascular events. The mean annual mortality rate was 7.2 percent in the single-chamber group and 7.4 percent in the dual-chamber group ( hazard ratio, 0.96; 95 percent confidence interval, 0.83 to 1.11). We found no significant differences between the group with single-chamber pacing and that with dual-chamber pacing in the rates of atrial fibrillation, heart failure, or a composite of stroke, transient ischemic attack, or other thromboembolism.CONCLUSIONSIn elderly patients with high-grade atrioventricular block, the pacing mode does not influence the rate of death from all causes during the first five years or the incidence of cardiovascular events during the first three years after implantation of a pacemaker.