Abstract:
Objectives: The aim of the study was to compare the clinical
outcomes [atrial fibrillation (AF), atrio-ventricular (AV)
block, device sepsis and lead revision] of patients with sinus
node dysfunction (SND) between atrial-pacing atrial-sensing
inhibited-response rate-adaptive (AAIR) versus dual-chamber
rate-adaptive (DDDR) pacing. The choice of AAIR
pacing versus DDDR pacing was determined by AV nodal
functional testing at implant.
Methods: We conducted a retrospective review of consecutive
patients who underwent AAIR and DDDR pacing over a
10-year period.
Results: One hundred and sixteen patients required pacing
for symptomatic SND. Fifty-four (46.6%) patients received
AAIR pacemakers and 62 (53.4%) received DDDR pacemakers
based on AV nodal functional testing at implant. Patients
who had AV Wenkebach with atrial pacing at 120 beats per
minute received DDDR pacing. Overall the mean age of
patients with SND was 65 years and 66.4% were females,
30% were diabetics and 71% were hypertensives. Pre-syncope/
syncope (84%) and dizziness (69%) were the most common
symptoms. Sinus pauses and sinus bradycardia were the most
common ECG manifestations. Over a median follow up of
five (IQR: 2–11) years, four patients (7.4%) developed AF
in the AAIR group compared to three (4.8%) in the DDDR
group (p = 0.70). AV block occurred in one patient in the
AAIR group, who required an upgrade to a DDDR pacemaker.
There was no difference in device sepsis or need for
lead revision between the two groups.
Conclusion: We found that AV nodal functional testing with
atrial pacing at the time of pacemaker implantation was a
useful tool to help guide the implanter between AAIR or
DDDR pacing. Patients who underwent AAIR pacing had a
low risk of AF, AV block or lead revision. In resource-limited
settings, AAIR pacing guided by AV nodal functional testing
should be considered as an alternative to DDDR pacing
