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Randomized Crossover Comparison of DDDR vs. VDD Pacing After Atrioventricular Junction Ablation for Prevention of Atrial Fibrillation - Randomized Crossover Comparison of DDDR vs. VDD Pacing After Atrioventricular Junction Ablation for Prevention of Atrial Fibrillation
Description:
Randomized Crossover Comparison of DDDR vs. VDD Pacing After Atrioventricular Junction Ablation for Prevention of Atrial Fibrillation.
Hypothesis:
The purpose of this study was to determine whether dual-chamber pacing offers an advantage over synchronized, single-chamber pacing in preventing atrial fibrillation (AF).
Study Design
Study Design:
Patients Enrolled: 67
Drug/Procedures Used:
After atrioventricular (AV) junction ablation for drug-refractory paroxysmal AF, 67 patients were randomized to DDDR or VDD pacing for 6 months, followed by crossover to the alternate pacing mode for another 6 months. The pacemakers were interrogated periodically to determine how much AF had occurred. Patients were not treated with antiarrhythmic drugs.
Principal Findings:
There were no significant differences between DDDR and VDD pacing in the mean time to first episode of AF (0.4-0.5 days), the AF burden at 6 months of follow-up (6.3–6.9 hrs/day) or in the proportion of patients with permanent AF at 6 months of follow-up (32–35%). At 1 year of follow-up, 43% of patients had permanent AF. In 15% of patients randomized to VDD pacing, crossover to DDDR pacing was required because of symptoms related to pacemaker syndrome.
Compared to VDD pacing, DDDR pacing does not prevent recurrences of AF or delay the development of permanent AF in patients with paroxysmal AF who are not being treated with antiarrhythmic drugs. Because almost 50% of patients develop permanent AF by 1 year of follow-up, VVIR pacing may be appropriate for many patients undergoing AV junction ablation.
Interpretation:
This well-designed study convincingly demonstrates that atrial-based pacing by itself does not prevent recurrences of atrial fibrillation. However, the study shows that AF remains paroxysmal after AV junction ablation in approximately 50% of patients and that 15% of patients with VDD pacing may develop a pacemaker syndrome. Therefore, contrary to the authors' conclusion, a DDD pacemaker with mode-switch capability should remain the device of choice after AV junction ablation in patients with paroxysmal AF.
References:
1. Gillis AM, Connolly SJ, and Lacombe P. Circulation 2000;102:736–41.
Keywords: Recurrence, Follow-Up Studies, Cardiac Pacing, Artificial, Dichlorodiphenyldichloroethane, Cost of Illness, Atrioventricular Node
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