© 1999 by European Society of Cardiology
Antiarrhythmic benefits of dual chamber stimulation with rate-response in patients with paroxysmal atrial fibrillation and chronotropic incompetence
A prospective, multicentre study
*Clinica Villa Tiberia Rome, Italy;
Fatebenefratelli Hospital Rome, Italy;
Civil Hospital Rome, Italy;
S. Camillo Hospital Rome, Italy;
||Policlinico S. Orsola Bologna, Italy;
¶Hospital S. Anna Como, Italy;
**Civil Hospital Brescia, Italy;
S. Agostino Hospital Modena, Italy;
Civil Hospital Gorizia, Italy;
Cannizzaro Hospital Catania, Italy;
||||University of Catania Catania, Italy
BACKGROUND: While the haemodynamic benefits of DDDR pacing compared with DDD pacing in patients with brady–tachy syndrome and chronotropic incompetence (CI) are well demonstrated, the antiarrhythmic advantage is controversial and so far not clearly demonstrated.
AIM: We have performed a prospective, randomized, multicentre study to evaluate the efficacy of DDDR and DDD pacing modes in preventing paroxysmal atrial fibrillation (PAF) episodes in patients with brady–tachy syndrome and CI.
METHODS AND RESULTS: Seventy-eight patients were included in the study. All patients had a dual chamber pacemaker implanted and were randomly programmed to DDD or DDDR with a cross over (DDD
DDDR or vice versa) at 3 months. The final evaluation was performed at 6 months by means of two self-administered symptom questionnaires to evaluate activity. Symptoms of palpitations were analysed and scored. The patients were less symptomatic with the DDDR mode. The number of mode-switch activations compared with symptomatic episodes of PAF confirmed the high rate of asymptomatic PAF episodes in patients with brady–tachy syndrome. We conclude that in a small but well defined population of patients affected by sick sinus syndrome with CI and severely symptomatic PAF, DDDR pacing compared with DDD pacing may offer an additional antiarrhythmic benefit and should be considered the primary mode of pacing.
Key Words: Dual chamber rate responsive pacing, sick sinus syndrome, chronotropic incompetence, antiarrhythmic effect of pacing, paroxysmal atrial arrhythmias
Correspondence: Prof. Fulvio Bellocci MD, Policlinico Universitario ‘A. Gemelli’, Istituto di Cardiologia Largo Agostino Gemelli, 8, 00168 Roma, Italy.
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