BACKGROUND: Several reports suggest that the incidence of stroke and atrial fibrillation is reduced in patients receiving physiologic pacemakers, compared with patients receiving a ventricular pacemaker. HYPOTHESIS: The study was undertaken to address the impact of different pacing modalities on the incidence of stroke and atrial fibrillation. METHODS: We prospectively analyzed 210 consecutive patients. Those with previous episodes of cerebral ischemia and/or atrial fibrillation were excluded from the study. The study population included 100 patients paced for total atrioventricular (AV) block or second-degree AV block (type II Mobitz) and 110 patients paced for sick sinus syndrome (SSS). The pacing mode was randomized. All patients underwent a brain computed tomography (CT) scan at the date of enrollment and after 1 and 2 years. Patients were followed for 2 years, and the incidence of atrial fibrillation and stroke was evaluated. RESULTS: The incidence of atrial fibrillation was 10% at 1 year and 11% at 2 years. Comparing the different pacing modalities, we reported an increase in the incidence of atrial fibrillation in patients receiving ventricular pacing (p < 0.05). On the other hand, no difference was found between patients paced for AV block and those paced for SSS. At the end of follow-up, we reported 29 cases of cerebral ischemia: 9 patients had AV block while 20 had SSS (p < 0.05). Comparing the different pacing modalities, there was an increase in the incidence of stroke in patients receiving ventricular pacing (p < 0.05). CONCLUSION: There was an increase in the incidence of stroke and atrial fibrillation in patients with ventricular pacing.
RCT Entities:
BACKGROUND: Several reports suggest that the incidence of stroke and atrial fibrillation is reduced in patients receiving physiologic pacemakers, compared with patients receiving a ventricular pacemaker. HYPOTHESIS: The study was undertaken to address the impact of different pacing modalities on the incidence of stroke and atrial fibrillation. METHODS: We prospectively analyzed 210 consecutive patients. Those with previous episodes of cerebral ischemia and/or atrial fibrillation were excluded from the study. The study population included 100 patients paced for total atrioventricular (AV) block or second-degree AV block (type II Mobitz) and 110 patients paced for sick sinus syndrome (SSS). The pacing mode was randomized. All patients underwent a brain computed tomography (CT) scan at the date of enrollment and after 1 and 2 years. Patients were followed for 2 years, and the incidence of atrial fibrillation and stroke was evaluated. RESULTS: The incidence of atrial fibrillation was 10% at 1 year and 11% at 2 years. Comparing the different pacing modalities, we reported an increase in the incidence of atrial fibrillation in patients receiving ventricular pacing (p < 0.05). On the other hand, no difference was found between patients paced for AV block and those paced for SSS. At the end of follow-up, we reported 29 cases of cerebral ischemia: 9 patients had AV block while 20 had SSS (p < 0.05). Comparing the different pacing modalities, there was an increase in the incidence of stroke in patients receiving ventricular pacing (p < 0.05). CONCLUSION: There was an increase in the incidence of stroke and atrial fibrillation in patients with ventricular pacing.
Authors: Y Sasaki; M Shimotori; K Akahane; H Yonekura; K Hirano; R Endoh; S Koike; S Kawa; S Furuta; T Homma Journal: Pacing Clin Electrophysiol Date: 1988-11 Impact factor: 1.976
Authors: J L Cox; J P Boineau; R B Schuessler; T B Ferguson; M E Cain; B D Lindsay; P B Corr; K M Kater; D G Lappas Journal: JAMA Date: 1991-10-09 Impact factor: 56.272