Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Faculté de Médecine, Université François Rabelais, 37000 Tours, France.
Service d'Information Médicale, D'épidémiologie et d'Économie de la Santé, Centre Hospitalier Universitaire et EA7505, Faculté de Médecine, Université François Rabelais, 37000 Tours, France.
Europace. 2024 Aug 30;26(9). doi: 10.1093/europace/euae238.
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 (hazard ratio (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 ischaemic stroke (HR 0.873, P = 0.008) in the dual-chamber pacemaker group than in the single-chamber pacemaker group. Regarding re-interventions 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 haematomas (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 risk of mortality, heart failure, atrial fibrillation, and stroke during follow-up.
在伴有窦性节律的完全性房室传导阻滞（AVB）中，建议植入双腔起搏器而非单腔起搏器。然而，尚无大规模研究能够证明这种选择在硬临床终点（如病死率）方面具有优势。
这项回顾性观察性研究基于法国 2013 年 1 月至 2022 年 12 月期间国家行政数据库，纳入了所有因伴有窦性节律的完全性 AVB 而接受初次起搏器植入的患者。经倾向评分匹配后，我们获得了两组各包含 19219 例患者的队列。双腔起搏器组的全因死亡率为 9.22%/年，而单腔起搏器组为 11.48%/年（风险比[HR]0.807，P<0.0001）。同样，双腔起搏器组心血管死亡率（HR 0.766，P<0.0001）、心力衰竭（HR 0.908，P<0.0001）、心房颤动（HR 0.778，P<0.0001）和缺血性卒中等发生率更低，而心房颤动（HR 0.778，P<0.0001）和缺血性卒中等发生率更低。在再干预和并发症方面，双腔起搏器组升级（附加心房导联或左心室导联）较少（HR 0.210，P<0.0001），但血肿（HR 1.179，P=0.006）和导联重定位（HR 1.123，P=0.04）更多。
在伴有窦性节律的完全性 AVB 适应证中，我们的结果与当前推荐一致，即对于这些患者，首选植入双腔起搏器而非单腔起搏器。植入双腔起搏器与随访期间的死亡率、心力衰竭、心房颤动和卒中等风险降低相关。
