Atrial pacing minimization in sinus node dysfunction and risk of incident atrial fibrillation: a randomized trial

Mads Brix Kronborg*, Maria Hee Jung Park Frausing, Jerzy Malczynski, Sam Riahi, Jens Haarbo, Katja Fiedler Holm, Charlotte Ellen Larroudé, Andi Eie Albertsen, Lene Svendstrup, Ulrik Hintze, Ole Dyg Pedersen, Ulla Davidsen, Thomas Fischer, Jens Brock Johansen, Jens Kristensen, Christian Gerdes, Jens Cosedis Nielsen, for the DANPACE II Investigators

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

2 Downloads (Pure)

Abstract

BACKGROUND AND AIMS: High percentages of atrial pacing have been associated with an increased risk of atrial fibrillation. This study is aimed at evaluating whether atrial pacing minimization in patients with sinus node dysfunction reduces the incidence of atrial fibrillation.

METHODS: In a nationwide, randomized controlled trial, 540 patients with sinus node dysfunction and an indication for first pacemaker implantation were assigned to pacing programmed to a base rate of 60 bpm and rate-adaptive pacing (DDDR-60) or pacing programmed to a base rate of 40 bpm without rate-adaptive pacing (DDD-40). Patients were followed on remote monitoring for 2 years. The primary endpoint was time to first episode of atrial fibrillation longer than 6 min. Secondary endpoints included longer episodes of atrial fibrillation, and the safety endpoint comprised a composite of syncope or presyncope.

RESULTS: The median percentage of atrial pacing was 1% in patients assigned to DDD-40 and 49% in patients assigned to DDDR-60. The primary endpoint occurred in 124 patients (46%) in each treatment group (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.76-1.25, P = .83). There were no between-group differences in atrial fibrillation exceeding 6 or 24 h, persistent atrial fibrillation, or cardioversions for atrial fibrillation. The incidence of syncope or presyncope was higher in patients assigned to DDD-40 (HR 1.71, 95% CI 1.13-2.59, P = .01).

CONCLUSIONS: Atrial pacing minimization in patients with sinus node dysfunction does not reduce the incidence of atrial fibrillation. Programming a base rate of 40 bpm without rate-adaptive pacing is associated with an increased risk of syncope or presyncope.

Original languageEnglish
JournalEuropean Heart Journal
Volume44
Issue number40
Pages (from-to)4246-4255
ISSN0195-668X
DOIs
Publication statusPublished - 21. Oct 2023

Keywords

  • Atrial fibrillation
  • Atrial pacing
  • Pacemaker
  • Quality of life
  • Sinus node disease
  • Syncope

Fingerprint

Dive into the research topics of 'Atrial pacing minimization in sinus node dysfunction and risk of incident atrial fibrillation: a randomized trial'. Together they form a unique fingerprint.

Cite this