Atrial pacing minimization did not lower AF incidence in sinus node dysfunction
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Key takeaways:
- Rate-modulated pacing at 60 bpm did not reduce AF incidence vs. nonadaptive pacing at 40 bpm in patients with sinus node dysfunction.
- Adaptive pacing reduced syncope or presyncope vs. nonadaptive pacing.
Adaptive pacing at a 60 bpm base rate did not reduce atrial fibrillation risk in patients with sinus node dysfunction but did reduce the incidence of syncope or presyncope vs. a 40 bpm base rate without adaptive pacing, a speaker reported.
The results of the investigator-initiated multicenter DANPACE II trial were presented at the European Society of Cardiology Congress and simultaneously published in the European Heart Journal.
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“Patients with sinus node disease often have atrial fibrillation. There are some observational studies showing that higher percentage of atrial pacing is associated with a higher risk of atrial fibrillation,” Mads Brix Kronborg, MD, PhD, DMSc, clinical associate professor in the department of clinical medicine at Aarhus University, Denmark, said during a press conference. “Whether or not this is due to a prolongation and abnormal activation of the atrium or [whether] these patients just have more progressive disease and therefore are in need of more atrial pacing is not known. Therefore, we had the question, does minimized atrial pacing in patients with sinus node dysfunction reduce the risk of atrial fibrillation?”
For the DANPACE II trial, the researchers enrolled 540 patients with sinus node dysfunction who underwent first implant of a pacemaker and subsequently received remote monitoring for 2 years. Patients with persistent or permanent AF at baseline were excluded before randomization. Patients were assigned to a dual-chamber pacemaker with a base rate of 40 bpm or a dual-chamber rate-modulated pacemaker with a base rate of 60 bpm.
The primary endpoint was AF lasting more than 6 minutes. The safety endpoint was the occurrence of syncope or presyncope. Secondary endpoints included change in quality of life, as assessed via SF-36 physical and mental component scores, and 6-minute walk test.
Kronborg reported no significant difference in the occurrence of the primary endpoint between the two study arms (46% vs. 46%; HR = 0.97; 95% CI, 0.76-1.25; log-rank P = .83).
Occurrence of syncope or presyncope was more common in patients assigned to pacing with a base rate of 40 bpm compared with those assigned to a rate-modulated pacemaker with a base rate of 60 bpm (22% vs. 13%; HR = 1.71; 95% CI, 1.13-2.59; log-rank P = .01), according to the presentation.
Moreover, there was no significant difference in change of quality of life or 6-minute walk distance between the two groups.
“Atrial pacing minimization in patients with sinus node disease does not reduce the incidence of atrial fibrillation,” Kronborg said during the press conference. “Programming a base rate of 40 beats per minute without rate-adaptive pacing was associated with an increased risk of syncope or presyncope.”
Reference:
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Kronborg MB, et al. Hot Line 7. Presented at: European Society of Cardiology Congress; Aug. 25-28, 2023; Amsterdam (hybrid meeting).
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