Skanes A C, Krahn A D, Yee R, Klein G J, Connolly S J, Kerr C R, Gent M, Thorpe K E, Roberts R S
Division of Cardiology, University of Western Ontario, London, Canada.
J Am Coll Cardiol. 2001 Jul;38(1):167-72. doi: 10.1016/s0735-1097(01)01326-2.
This study examined the effect of physiologic pacing on the development of chronic atrial fibrillation (CAF) in the Canadian Trial Of Physiologic Pacing (CTOPP).
The role of physiologic pacing to prevent CAF remains unclear. Small randomized studies have suggested a benefit for patients with sick sinus syndrome. No data from a large randomized trial are available.
The CTOPP randomized patients undergoing first pacemaker implant to ventricular-based or physiologic pacing (AAI or DDD). Patients who were prospectively found to have persistent atrial fibrillation (AF) lasting greater than or equal to one week were defined as having CAF. Kaplan-Meier plots for the development of CAF were compared by log-rank test. The effect of baseline variables on the benefit of physiologic pacing was evaluated by Cox proportional hazards modeling.
Physiologic pacing reduced the development of CAF by 27.1%, from 3.84% per year to 2.8% per year (p = 0.016). Three clinical factors predicted the development of CAF: age > or =74 years (p = 0.057), sinoatrial (SA) node disease (p < 0.001) and prior AF (p < 0.001). Subgroup analysis demonstrated a trend for patients with no history of myocardial infarction or coronary disease (p = 0.09) as well as apparently normal left ventricular function (p = 0.11) to derive greatest benefit.
Physiologic pacing reduces the annual rate of development of chronic AF in patients undergoing first pacemaker implant. Age > or =74 years, SA node disease and prior AF predicted the development of CAF. Patients with structurally normal hearts appear to derive greatest benefits.
本研究在加拿大生理性起搏试验（CTOPP）中探讨了生理性起搏对慢性房颤（CAF）发生发展的影响。
生理性起搏预防CAF的作用尚不清楚。小型随机研究提示对病态窦房结综合征患者有益。尚无大型随机试验的数据。
CTOPP将首次植入起搏器的患者随机分为心室起搏或生理性起搏（AAI或DDD）。前瞻性发现有持续房颤（AF）且持续时间大于或等于1周的患者被定义为患有CAF。通过对数秩检验比较CAF发生的Kaplan-Meier曲线。通过Cox比例风险模型评估基线变量对生理性起搏益处的影响。
生理性起搏使CAF的发生率降低了27.1%，从每年3.84%降至每年2.8%（p = 0.016）。三个临床因素可预测CAF的发生：年龄≥74岁（p = 0.057）、窦房（SA）结疾病（p < 0.001）和既往房颤（p < 0.001）。亚组分析显示，无心肌梗死或冠心病病史的患者（p = 0.09）以及左心室功能明显正常的患者（p = 0.11）有获得最大益处的趋势。
生理性起搏可降低首次植入起搏器患者慢性房颤的年发生率。年龄≥74岁、SA结疾病和既往房颤可预测CAF的发生。心脏结构正常的患者似乎获益最大。
