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From the Department of Cardiology, Skejby Sygehus, Aarhus University
Hospital, Aarhus, Denmark.
Correspondence to Henning Rud Andersen, MD, DMSc, Department of Cardiology, Skejby Sygehus, Aarhus University Hospital, 8200 Aarhus N, Denmark.
Background—In patients with sick
sinus syndrome, choice of pacing mode has been implicated in the
development of congestive heart failure.
Methods and Results—A total of 225 consecutive patients with sick
sinus syndrome and intact atrioventricular conduction
were randomized to either single-chamber atrial pacing (n=110) or
single-chamber ventricular pacing (n=115). Clinical
assessment included New York Heart Association classification,
medication, and M-mode echocardiography before
pacemaker implantation, after 3 months, and subsequently once every
year. At long-term follow-up (mean, 5.5±2.4 years), NYHA class was
higher in the ventricular group than in the atrial group
(NYHA class I/II/III/IV: 65/44/4/0 versus 84/22/2/1 patients,
P=.010). Increase in NYHA class during follow-up was
observed in 35 of 113 patients in the ventricular group
versus 10 of 109 in the atrial group (P<.0005).
Increase in dose of diuretics from randomization to last
follow-up was significantly higher in the ventricular group
than in the atrial group (21±49 versus 8±42 mg furosemide/d,
P=.033). The left ventricular fractional
shortening decreased significantly in the ventricular group
(from 0.36±0.12 to 0.31±0.08, P<.0005) but not in the
atrial group (from 0.35±0.13 to 0.33±0.09, P=.087).
The left atrial diameter increased significantly in both treatment
groups (ventricular group: from 34±7 to 41±7 mm,
P<.0005; atrial group: from 34±6 to 37±7 mm,
P=.002), but the increase was significantly higher in
the ventricular group than in the atrial group
(P<.0005).
Conclusions—During long-term follow-up, ventricular
pacing is associated with a higher incidence of congestive heart
failure and consumption of diuretics than atrial pacing. This
is accompanied by a decrease in left ventricular fractional
shortening and an increased dilatation of the left atrium in the
ventricular paced patients.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Heart Failure and Echocardiographic Changes During Long-term Follow-up of Patients With Sick Sinus Syndrome Randomized to Single-Chamber Atrial or Ventricular Pacing
Key Words: sick sinus syndrome • pacing • echocardiography • heart failure • ventricles
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