Heart failure in patients with sick sinus syndrome treated with single lead atrial or dual-chamber pacing: No association with pacing mode or right ventricular pacing site

Abstract

AimsPrevious studies indicate that ventricular pacing may precipitate heart failure (HF). We investigated occurrence of HF during long-term follow-up among patients with sick sinus syndrome (SSS) randomized to AAIR or DDDR pacing. Furthermore, we investigated effects of percentage of ventricular pacing (VP) and pacing site in the ventricle.Methods and resultsWe analysed data from 1415 patients randomized to AAIR (n 707) or DDDR pacing (n 708). Ventricular pacing leads were recorded as located in either an apical or a non-apical position. The VP and HF hospitalizations were recorded during follow-up. Patients were classified with new HF, if in New York Heart Association (NYHA) functional class IV or if presence of <2 of: oedema; dyspnoea; NYHA functional class III. Mean follow-up was 5.4 ± 2.4 years. Heart failure hospitalizations did not differ between groups. In the AAIR group, 170 of the 707 (26) patients developed HF vs. 169 of the 708 (26) patients in the DDDR group, hazard rate ratio (HR) 1.00, 95 confidence interval (CI) 0.791.22, P 0.87. In DDDR patients, 146 of the 512 patients (29) with ventricular leads in an apical position developed HF vs. 28 of the 161 patients (17) with the leads in a non-apical position, HR 0.67, CI 0.451.00, P 0.05. After adjustments this difference was non-significant. The incidence of HF was not associated with VP (P 0.57).ConclusionIn patients with SSS, HF was not associated with pacing mode, VP, or ventricular lead localization. This suggests that DDDR pacing is safe in patients with SSS without precipitating HF. © The Author 2012.