Prospective Randomized Study to Assess the Efficacy of Site and Rate of Atrial Pacing on Long-Term Progression of Atrial Fibrillation in Sick Sinus Syndrome: Septal Pacing for Atrial Fibrillation Suppression Evaluation (SAFE) Study

Title
Prospective Randomized Study to Assess the Efficacy of Site and Rate of Atrial Pacing on Long-Term Progression of Atrial Fibrillation in Sick Sinus Syndrome: Septal Pacing for Atrial Fibrillation Suppression Evaluation (SAFE) Study
Author(s)
신동구Lau Chu Pak[Lau Chu Pak]Ngarmukos Tachapong[Ngarmukos Tachapong]Chun Chieh Wang[Chun Chieh Wang]Jing feng Wang[Jing feng Wang]Haruhiko Abe[Haruhiko Abe]Hung Fat Tse[Hung Fat Tse]Chi Woon Kong[Chi Woon Kong]Reginald Liew[Reginald Liew]You-Ho Kim[You-Ho Kim]
Keywords
NODE DYSFUNCTION; INTERATRIAL SEPTUM; LEAD PLACEMENT; PACEMAKER; TRIAL; PREVENTION; SELECTION; DISEASE; METAANALYSIS; STROKE
Issue Date
201308
Publisher
LIPPINCOTT WILLIAMS & WILKINS
Citation
CIRCULATION, v.128, no.7, pp.687 - 693
Abstract
Background-Atrial-based pacing is associated with lower risk of atrial fibrillation (AF) in sick sinus syndrome compared with ventricular pacing; nevertheless, the impact of site and rate of atrial pacing on progression of AF remains unclear. We evaluated whether long-term atrial pacing at the right atrial (RA) appendage versus the low RA septum with (ON) or without (OFF) a continuous atrial overdrive pacing algorithm can prevent the development of persistent AF. Methods and Results-We randomized 385 patients with paroxysmal AF and sick sinus syndrome in whom a pacemaker was indicated to pacing at RA appendage ON (n=98), RA appendage OFF (n=99), RA septum ON (n=92), or RA septum OFF (n=96). The primary outcome was the occurrence of persistent AF (AF documented at least 7 days apart or need for cardioversion). Demographic data were homogeneous across both pacing site (RA appendage/RA septum) and atrial overdrive pacing (ON/OFF). After a mean follow-up of 3.1 years, persistent AF occurred in 99 patients (25.8%; annual rate of persistent AF, 8.3%). Alternative site pacing at the RA septum versus conventional RA appendage (hazard ratio=1.18; 95% confidence interval, 0.79-1.75; P=0.65) or continuous atrial overdrive pacing ON versus OFF (hazard ratio=1.17; 95% confidence interval, 0.79-1.74; P=0.69) did not prevent the development of persistent AF. Conclusions-In patients with paroxysmal AF and sick sinus syndrome requiring pacemaker implantation, an alternative atrial pacing site at the RA septum or continuous atrial overdrive pacing did not prevent the development of persistent AF.
URI
http://hdl.handle.net/YU.REPOSITORY/29242http://dx.doi.org/10.1161/CIRCULATIONAHA.113.001644
ISSN
0009-7322
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의과대학 > 내과학교실 > Articles
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