Saksena Sanjeev, Prakash Atul, Ziegler Paul, Hummel John D, Friedman Paul, Plumb Vance J, Wyse D George, Johnson Eric, Fitts Stephanie, Mehra Rahul
Cardiovascular Institute, Atlantic Health System, Passaic, New Jersey 07055, USA.
J Am Coll Cardiol. 2002 Sep 18;40(6):1140-50; discussion 1151-2. doi: 10.1016/s0735-1097(02)02068-5.
We compared the safety, tolerance and effectiveness of overdrive high right atrial (RA), dual-site RA and support (DDI or VDI) pacing (SP) in patients with symptomatic atrial fibrillation (AF) and bradycardias.
Optimal pacing methods for AF prevention remain unclear.
Patients (n = 118) were randomized to each of three pacing modes in a crossover trial.
Mode adherence was superior for dual-site RA (5.8 months) compared with SP (3.3 months; p < 0.001) and high RA pacing (4.7 months; p = 0.006). Adverse event-free survival improved with dual-site RA (p = 0.007 vs. SP) and was comparable to high RA (p = 0. 75). AF-free survival trended to improve with dual-site RA (hazard ratio [HR] 0.715, p = 0.07 vs. SP) but not high RA (HR = 0.71, p = 0.19) or when dual-site RA was compared with high RA (HR = 0.835, p = 0.175). Time-to-recurrence was longer in dual-site RA (1.77 months) compared with high RA (0.62 months, p < 0.09) or SP (0.44 months, p < 0.05). In antiarrhythmic drug-treated patients, dual-site RA reduced recurrence risk compared with SP (HR = 0.638, p = 0.011) and high RA (HR = 0.669, p = 0.06). In patients with < or =1 AF event/week, dual-site RA improved AF suppression (HR = 0.464, p = 0.004 vs. SP; HR = 0.623, p = 0.006 vs. high RA). Dual-site RA improved AF-free and mode survival (p < 0.03 vs. high RA, p < 0.001 vs. SP) and reduced asymptomatic AF (p < 0.01 vs. high RA).
Dual-site RA is safe and better tolerated than high RA and SP. In patients on antiarrhythmics, dual-site RA prolonged and high RA trended to prolong time-to-recurrent AF compared with SP. Dual-site RA provides superior symptomatic and asymptomatic AF prevention compared with high RA in patients with symptomatic AF frequency of < or =1/week.
我们比较了超速右房高位起搏（RA）、双部位RA起搏和支持性（DDI或VDI）起搏（SP）在有症状性心房颤动（AF）和心动过缓患者中的安全性、耐受性和有效性。
预防AF的最佳起搏方法仍不明确。
在一项交叉试验中，将118例患者随机分为三种起搏模式。
与SP（3.3个月；p<0.001）和右房高位起搏（4.7个月；p = 0.006）相比，双部位RA起搏的模式依从性更佳（5.8个月）。双部位RA起搏的无不良事件生存率有所提高（与SP相比，p = 0.007），与右房高位起搏相当（p = 0.75）。双部位RA起搏的无AF生存率有改善趋势（风险比[HR]0.715，与SP相比，p = 0.07），但右房高位起搏无此趋势（HR = 0.71，p = 0.19），双部位RA起搏与右房高位起搏相比也无此趋势（HR = 0.835，p = 0.175）。双部位RA起搏的复发时间（1.77个月）比右房高位起搏（0.62个月，p<0.09）或SP（0.44个月，p<0.05）更长。在接受抗心律失常药物治疗的患者中，与SP（HR = 0.638，p = 0.011）和右房高位起搏（HR = 0.669，p = 0.06）相比，双部位RA起搏降低了复发风险。在每周AF发作≤1次的患者中，双部位RA起搏改善了AF抑制情况（与SP相比，HR = 0.464，p = 0.004；与右房高位起搏相比，HR = 0.623，p = 0.006）。双部位RA起搏改善了无AF和模式生存率（与右房高位起搏相比，p<0.03；与SP相比，p<0.001），并减少了无症状AF（与右房高位起搏相比，p<0.01）。
双部位RA起搏安全，耐受性优于右房高位起搏和SP。在接受抗心律失常药物治疗的患者中，与SP相比，双部位RA起搏延长了AF复发时间，右房高位起搏有此趋势。在有症状性AF发作频率≤1次/周的患者中，与右房高位起搏相比，双部位RA起搏在预防有症状和无症状AF方面更具优势。
