Department of Cardiology, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, DK-8200 Aarhus N, Denmark.
Europace. 2013 Aug;15(8):1166-73. doi: 10.1093/europace/eut039. Epub 2013 Feb 28.
To investigate the indications for system upgrade with single lead atrial pacing (AAIR), complications associated with these re-interventions, and possible predictors for system upgrade among patients included in the Danish Multicenter Randomized Trial on AAIR vs. dual-chamber pacing (DDDR) in sick sinus syndrome (DANPACE).
A total of 707 of 1415 patients were randomized to AAIR pacing. Mean follow-up was 5.5 ± 2.6 years. Information on indications for system upgrade and complications were collected by reviewing patient charts. Multiple logistic regression was used to estimate adjusted odds ratios (aOR) with 95% confidence intervals (CI) for the association between predictors and system upgrade. Sixty-six patients (9.3%) in the AAIR group underwent system upgrade. Fifty-nine of these patients (89.3%) had a documented class I indication for system upgrade. Age (aOR 0.98 for each 1-year increase in age; 95% CI 0.6-1.0), and left atrial enlargement (aOR 1.9; 95% CI 1.0-3.8) were predictors for system upgrade. No single clinically applicable predictor for upgrade was identified. A total of 11 patients (16.7%) experienced at least one major complication after system upgrade.
The majority of patients with AAIR pacing who underwent system upgrade had a class I indication. The incidence of major complications after system upgrade was high. The present data support the use of DDDR pacing rather than AAIR pacing in sick sinus syndrome.
调查单腔心房起搏（AAIR）系统升级的适应证、这些再干预相关的并发症，以及丹麦多中心 AAIR 与双腔起搏（DDDR）治疗病态窦房结综合征（DANPACE）随机试验中纳入的患者进行系统升级的可能预测因素。
共有 1415 例患者中的 707 例被随机分配至 AAIR 起搏。平均随访时间为 5.5±2.6 年。通过查阅患者病历收集系统升级的适应证和并发症信息。采用多元逻辑回归分析来估计预测因素与系统升级之间的关联的调整比值比（aOR）及其 95%置信区间（CI）。AAIR 组中有 66 例（9.3%）患者进行了系统升级。这些患者中有 59 例（89.3%）有记录的 I 类系统升级适应证。年龄（每增加 1 岁，aOR 为 0.98；95%CI 0.6-1.0）和左心房扩大（aOR 1.9；95%CI 1.0-3.8）是系统升级的预测因素。未确定单一的可用于升级的临床预测因素。总共有 11 例（16.7%）患者在系统升级后至少发生了 1 次重大并发症。
接受 AAIR 起搏系统升级的患者中，大多数有 I 类适应证。系统升级后的重大并发症发生率较高。目前的数据支持在病态窦房结综合征中使用 DDDR 起搏而不是 AAIR 起搏。
