Dual chamber versus single chamber pacemaker in patients in sinus rhythm with an atrioventricular block: a nationwide cohort study.
atrio-ventricular block
cardiac pacing
Journal
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
ISSN: 1532-2092
Titre abrégé: Europace
Pays: England
ID NLM: 100883649
Informations de publication
Date de publication:
13 Sep 2024
13 Sep 2024
Historique:
received:
25
07
2024
revised:
31
08
2024
accepted:
12
09
2024
medline:
14
9
2024
pubmed:
14
9
2024
entrez:
13
9
2024
Statut:
aheadofprint
Résumé
In complete atrioventricular block (AVB) with underlying sinus rhythm, it is recommended to implant a dual-chamber pacemaker rather than a single-chamber pacemaker. However, no large-scale study has been able to demonstrate the superiority of this choice on hard clinical criteria such as morbimortality. This retrospective observational study included all patients who received a primary pacemaker implantation in the indication of complete AVB with underlying sinus rhythm in France, based on the national administrative database between January 2013 and December 2022. After propensity score matching, we obtained two groups containing 19,219 patients each. The incidence of all-cause mortality was 9.22%/year for the dual-chamber pacemaker group, compared with 11.48%/year for the single-chamber pacemaker group (HR 0.807, p<0.0001). Similarly, there was a lower incidence of cardiovascular mortality (HR 0.766, p<0.0001), heart failure (HR 0.908, p<0.0001), atrial fibrillation (HR 0.778, p<0.0001) and ischemic stroke (HR 0.873, p=0.008) in the dual-chamber pacemaker group than in the single-chamber pacemaker group. Regarding reinterventions and complications, there were fewer upgrades (addition of atrial lead or left ventricular lead) in the dual chamber group (HR 0.210, p<0.0001), but more hematomas (HR 1.179, p=0.006) and lead repositioning (HR 1.123, p=0.04). In the indication of complete AVB with underlying sinus rhythm, our results are consistent with current recommendations to prefer implantation of a dual-chamber pacemaker rather than a single-chamber pacemaker for these patients. Implantation of a dual-chamber pacemaker is associated with a lower risks of mortality, heart failure, atrial fibrillation, and stroke during follow-up.
Sections du résumé
BACKGROUND
BACKGROUND
In complete atrioventricular block (AVB) with underlying sinus rhythm, it is recommended to implant a dual-chamber pacemaker rather than a single-chamber pacemaker. However, no large-scale study has been able to demonstrate the superiority of this choice on hard clinical criteria such as morbimortality.
METHODS
METHODS
This retrospective observational study included all patients who received a primary pacemaker implantation in the indication of complete AVB with underlying sinus rhythm in France, based on the national administrative database between January 2013 and December 2022.
RESULTS
RESULTS
After propensity score matching, we obtained two groups containing 19,219 patients each. The incidence of all-cause mortality was 9.22%/year for the dual-chamber pacemaker group, compared with 11.48%/year for the single-chamber pacemaker group (HR 0.807, p<0.0001). Similarly, there was a lower incidence of cardiovascular mortality (HR 0.766, p<0.0001), heart failure (HR 0.908, p<0.0001), atrial fibrillation (HR 0.778, p<0.0001) and ischemic stroke (HR 0.873, p=0.008) in the dual-chamber pacemaker group than in the single-chamber pacemaker group. Regarding reinterventions and complications, there were fewer upgrades (addition of atrial lead or left ventricular lead) in the dual chamber group (HR 0.210, p<0.0001), but more hematomas (HR 1.179, p=0.006) and lead repositioning (HR 1.123, p=0.04).
CONCLUSION
CONCLUSIONS
In the indication of complete AVB with underlying sinus rhythm, our results are consistent with current recommendations to prefer implantation of a dual-chamber pacemaker rather than a single-chamber pacemaker for these patients. Implantation of a dual-chamber pacemaker is associated with a lower risks of mortality, heart failure, atrial fibrillation, and stroke during follow-up.
Identifiants
pubmed: 39271128
pii: 7756614
doi: 10.1093/europace/euae238
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.