Published Online
on January 5, 2004

A more recent version of this article appeared on January 27, 2004

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Submitted on April 8, 2003
Revised on October 20, 2003
Accepted on October 21, 2003

Canadian Trial of Physiological Pacing. Effects of Physiological Pacing During Long-Term Follow-Up

Charles R. Kerr MD^*, Stuart J. Connolly MD, Hoshiar Abdollah MB, ChB, Robin S. Roberts MTech, Michael Gent DSc, Salim Yusuf DPhil, Anne M. Gillis MD, Anthony S.L. Tang MD, Mario Talajic MD, George J. Klein MD, David M. Newman MD, and for the Canadian Trial of Physiological Pacing (CTOPP) Investigators

From the Department of Medicine, University of British Columbia, Vancouver (C.R.K.); the Departments of Medicine (S.J.C., S.Y.) and Clinical Epidemiology and Biostatistics (R.S.R., M.G.), McMaster University, Hamilton, Ontario; the Department of Medicine, University of Calgary, Calgary, Alberta (A.M.G.); the Department of Medicine, University of Ottawa, Ottawa, Ontario (A.S.L.T.); the Institut de Cardiologie de Montreal, Montreal, Quebec (M.T.); the Department of Medicine, Queens University, Kingston, Ontario (H.A.); the Department of Medicine, University of Western Ontario, London, Ontario (G.J.K.); and the Department of Medicine, University of Toronto, Toronto, Ontario (D.M.N.), Canada.

^* To whom correspondence should be addressed. E-mail: ckerr{at}providencehealth.bc.ca.

Background--The Canadian Trial of Physiological Pacing (CTOPP) reported that the risk of stroke or cardiovascular death was similar between patients receiving ventricular versus physiological pacemakers at the end of the original follow-up period of 3 years. However, the occurrence of atrial fibrillation was significantly less frequent with physiological pacemakers. To assess a potential delayed benefit of physiological pacing, follow-up of patients in this study was extended to 6 years.

Methods and Results--A total of 1474 patients requiring a pacemaker for symptomatic bradycardia were randomized to receive ventricular and 1094 to physiological pacemakers. The primary outcome was stroke or cardiovascular death. The study was completed in July 1998, and follow-up was extended to July 2001. At a mean follow-up of 6.4 years, there was no difference between treatment groups in the primary outcome of cardiovascular death or stroke. There was no significant difference in total mortality or stroke between groups. There was a significantly lower rate of development of atrial fibrillation in the physiological group, with a relative risk reduction of 20.1% (CI, 5.4 to 32.5; P=0.009).

Conclusions--The CTOPP extended study does not show a difference in cardiovascular death or stroke, or in total mortality, or in stroke between patients implanted with ventricular or physiological pacemakers over a mean follow-up of >6 years. However, there is a persistent significant reduction in the development of atrial fibrillation with physiological pacing.

Key words: pacemakers • mortality • stroke • fibrillation

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