Lamas Gervasio A, Lee Kerry L, Sweeney Michael O, Silverman Russell, Leon Angel, Yee Raymond, Marinchak Roger A, Flaker Greg, Schron Eleanor, Orav E John, Hellkamp Anne S, Greer Stephen, McAnulty John, Ellenbogen Kenneth, Ehlert Frederick, Freedman Roger A, Estes N A Mark, Greenspon Arnold, Goldman Lee
Division of Cardiology, Mount Sinai Medical Center, and the University of Miami School of Medicine, Miami Beach, Fla, USA.
N Engl J Med. 2002 Jun 13;346(24):1854-62. doi: 10.1056/NEJMoa013040.
Dual-chamber (atrioventricular) and single-chamber (ventricular) pacing are alternative treatment approaches for sinus-node dysfunction that causes clinically significant bradycardia. However, it is unknown which type of pacing results in the better outcome.
We randomly assigned a total of 2010 patients with sinus-node dysfunction to dual-chamber pacing (1014 patients) or ventricular pacing (996 patients) and followed them for a median of 33.1 months. The primary end point was death from any cause or nonfatal stroke. Secondary end points included the composite of death, stroke, or hospitalization for heart failure; atrial fibrillation; heart-failure score; the pacemaker syndrome; and the quality of life.
The incidence of the primary end point did not differ significantly between the dual-chamber group (21.5 percent) and the ventricular-paced group (23.0 percent, P=0.48). In patients assigned to dual-chamber pacing, the risk of atrial fibrillation was lower (hazard ratio, 0.79; 95 percent confidence interval, 0.66 to 0.94; P=0.008), and heart-failure scores were better (P<0.001). The differences in the rates of hospitalization for heart failure and of death, stroke, or hospitalization for heart failure were not significant in unadjusted analyses but became marginally significant in adjusted analyses. Dual-chamber pacing resulted in a small but measurable increase in the quality of life, as compared with ventricular pacing.
In sinus-node dysfunction, dual-chamber pacing does not improve stroke-free survival, as compared with ventricular pacing. However, dual-chamber pacing reduces the risk of atrial fibrillation, reduces signs and symptoms of heart failure, and slightly improves the quality of life. Overall, dual-chamber pacing offers significant improvement as compared with ventricular pacing.
双腔（房室）起搏和单腔（心室）起搏是治疗引起临床显著心动过缓的窦房结功能障碍的两种替代方法。然而，尚不清楚哪种起搏类型能带来更好的结果。
我们将总共2010例窦房结功能障碍患者随机分为双腔起搏组（1014例患者）和心室起搏组（996例患者），并对他们进行了为期33.1个月的中位数随访。主要终点是任何原因导致的死亡或非致死性卒中。次要终点包括死亡、卒中或因心力衰竭住院的复合终点；心房颤动；心力衰竭评分；起搏器综合征；以及生活质量。
双腔起搏组（21.5%）和心室起搏组（23.0%，P=0.48）的主要终点发生率无显著差异。在接受双腔起搏的患者中，心房颤动的风险较低（风险比，0.79；95%置信区间，0.66至0.94；P=0.008），且心力衰竭评分更好（P<0.001）。在未调整分析中，心力衰竭住院率以及死亡、卒中或因心力衰竭住院的复合终点发生率的差异不显著，但在调整分析中变得略有显著。与心室起搏相比，双腔起搏导致生活质量有小幅但可测量的提高。
在窦房结功能障碍中，与心室起搏相比，双腔起搏并不能改善无卒中生存期。然而，双腔起搏可降低心房颤动的风险，减轻心力衰竭的体征和症状，并略微改善生活质量。总体而言，与心室起搏相比，双腔起搏有显著改善。
