Original Article
Single-Chamber versus Dual-Chamber Pacing for High-Grade Atrioventricular Block
N Engl J Med 2005; 353:145-155July 14, 2005
- Abstract
Background
In the treatment of atrioventricular block, dual-chamber cardiac pacing is thought to confer a clinical benefit as compared with single-chamber ventricular pacing, but the supporting evidence is mainly from retrospective studies. Uncertainty persists regarding the true benefits of dual-chamber pacing, particularly in the elderly, in whom it is used less often than in younger patients.
Methods
In a multicenter, randomized, parallel-group trial, 2021 patients 70 years of age or older who were undergoing their first pacemaker implant for high-grade atrioventricular block were randomly assigned to receive a single-chamber ventricular pacemaker (1009 patients) or a dual-chamber pacemaker (1012 patients). In the single-chamber group, patients were randomly assigned to receive either fixed-rate pacing (504 patients) or rate-adaptive pacing (505 patients). The primary outcome was death from all causes. Secondary outcomes included atrial fibrillation, heart failure, and a composite of stroke, transient ischemic attack, or other thromboembolism.
Results
The median follow-up period was 4.6 years for mortality and 3 years for other cardiovascular events. The mean annual mortality rate was 7.2 percent in the single-chamber group and 7.4 percent in the dual-chamber group (hazard ratio, 0.96; 95 percent confidence interval, 0.83 to 1.11). We found no significant differences between the group with single-chamber pacing and that with dual-chamber pacing in the rates of atrial fibrillation, heart failure, or a composite of stroke, transient ischemic attack, or other thromboembolism.
Conclusions
In elderly patients with high-grade atrioventricular block, the pacing mode does not influence the rate of death from all causes during the first five years or the incidence of cardiovascular events during the first three years after implantation of a pacemaker.
Media in This Article
Figure 1
Cumulative Risk of Death from All Causes and from Cardiovascular Causes According to the Mode of Pacing.Figure 2
Cumulative Risk of Cardiovascular Events According to the Mode of Pacing.Article Activity
- Article
Cardiac pacing is the established treatment for high-grade atrioventricular block, but the appropriate pacing mode remains the subject of debate.1 Single-chamber ventricular pacing prevents bradycardia and death from ventricular standstill, but dual-chamber pacing better emulates normal cardiac physiology by restoring atrioventricular synchrony and matching the ventricular pacing rate to the sinus rate. As a result, dual-chamber pacing, as compared with single-chamber ventricular pacing, improves hemodynamic function,2-4 but the clinical benefit is uncertain.
Nonrandomized studies suggest that dual-chamber pacing is associated with a lower incidence of atrial fibrillation, stroke, and heart failure than is single-chamber pacing.5 There is also evidence of improved survival, but the data are confounded by selection bias, because of the preferential use of dual-chamber pacing in younger patients with fewer coexisting illnesses.6 Some current guidelines recommend dual-chamber pacing unless atrial fibrillation is present,7 but the limitations of the supporting data have led to questions about the guidelines8 and the apparent underuse of dual-chamber pacing, particularly in the elderly.9,10
The United Kingdom Pacing and Cardiovascular Events (UKPACE) trial compared the clinical benefits of single-chamber ventricular pacing and dual-chamber pacing in elderly patients with atrioventricular block.10
Methods
The UKPACE trial was a randomized, parallel-group trial conducted in 46 centers in the United Kingdom, representing a wide range of experience among centers and operators. The trial was approved by the North West Multi-Centre Research Ethics Committee and the local research ethics committee for each center. All patients provided written informed consent.
Patient Selection
Patients were recruited from August 22, 1995, to September 24, 1999. All new pacemaker implantations were registered, and trial eligibility was recorded. Eligible patients were 70 years of age or older and scheduled for their first pacemaker implantations for high-grade (i.e., second-degree or complete) atrioventricular block. Exclusion criteria included chronic established atrial fibrillation, New York Heart Association (NYHA) class IV heart failure, advanced cognitive dysfunction, total immobility, and advanced cancer (life expectancy of less than one year). Patients with persistent atrial fibrillation of less than three months' duration were eligible if they had undergone cardioversion and had normal sinus rhythm at enrollment.
Data Collection, Randomization, Implantation, and Programming
Baseline demographic and clinical characteristics of the patients were recorded by physicians, nurses, or cardiac technicians. Patients were randomly assigned, up to 24 hours before the scheduled implantation, to receive either a fixed-rate or rate-adaptive single-chamber ventricular pacing system or a dual-chamber system (with or without sensor-modulated rate adaptation). Within the single-chamber group, assignment to fixed-rate or rate-adaptive pacing was randomly determined. Randomization was performed with the use of a 24-hour automated telephone-based system, linked to a computer at the data center, with a dynamic balancing algorithm that stratified patients by center and age (<80 years or ≥80 years). Implantation was performed according to the operator's usual practice.
The use of sensor-based rate adaptation in the dual-chamber group and the programming of variables other than mode were determined by the investigator. Suggested settings for dual-chamber pacemakers were an atrioventricular delay of 150 msec, rate-adaptive atrioventricular shortening to 75 msec, and lower and upper rate limits of 60 beats per minute and 125 beats per minute, respectively. For rate-adaptive single-chamber pacemakers, the suggested lower and upper rate limits were 70 beats per minute and 125 beats per minute, respectively. For fixed-rate single-chamber pacemakers, a rate of 70 beats per minute was suggested. The operators and patients were not blinded to the type of pacing system used or the programming of the system.
End Point and Outcomes
The primary end point was death from all causes. Prespecified cardiovascular events included atrial fibrillation (defined as an episode, with or without symptoms, lasting 15 minutes or more and verified by electrocardiography), new or significantly worsening heart failure, a composite of stroke, transient ischemic attack, or other thromboembolism, revision of the pacing system, new-onset angina or newly diagnosed ischemic heart disease, and myocardial infarction. Crossover, in the event of suspected intolerance of the pacing mode, was at the discretion of the investigator.
Patients were followed for a minimum of 3 years, with scheduled visits at 1, 4, 10, 16, and 36 months, at which the pacemaker function was assessed and outcome events were recorded. Patients were given a diary in which the details of any medical contacts between their follow-up visits were to be recorded. The identity of enrolled patients was given to the U.K. Office for National Statistics, which provided automatic notification of registered deaths. Mortality data were censored on September 24, 2002. Data for other cardiovascular events were censored at the actual or intended date of the 36-month visit. If the visit was missed, outcome data were sought through a review of clinical records or through contact with the patient's family doctor. Deaths and specified cardiovascular events were adjudicated and classified by an independent committee on end points and events, with members unaware of the pacing modes. Deaths were classified as due to cardiovascular or noncardiovascular causes and treated as the result of cardiovascular causes if attributed to old age or if the cause was unclear. Safety was monitored by an independent data-monitoring committee.
Statistical Analysis
The database was maintained and analyzed by an independent data-management group (Nottingham Clinical Research Group, Nottingham, United Kingdom). The trial was designed to have a power of at least 90 percent to detect a 25 percent reduction in the primary end point, with a target recruitment of 2000 patients. This assumed an annual mortality rate of 8 percent in the single-chamber group, with allowance for a 6 percent crossover from single-chamber to dual-chamber pacing. More deaths were reported than anticipated, giving the study 95 percent power to detect a 25 percent reduction in mortality.
Differences in the proportion of ventricular beats that were paced were compared with the use of the Wilcoxon rank-sum test. Cumulative-event rates were calculated according to the Kaplan–Meier method,11 and differences between the groups were assessed with the use of the Cox proportional-hazards model,12 with adjustment for the baseline covariates of age (≤80 years vs. >80 years), sex, and NYHA class (I or II vs. III or IV). Relative risk was calculated after adjustment for age, sex, and NYHA class at baseline and expressed as hazard ratios with 95 percent confidence intervals. The primary analysis was the comparison of single-chamber and dual-chamber pacing. A prespecified secondary analysis involved the separate comparisons of fixed-rate and rate-adaptive single-chamber pacing with dual-chamber pacing. The impact of baseline covariates on the hazard ratio for the primary end point was assessed with the use of the log-rank test.13 The incidence of procedural and predischarge complications in the two groups was compared with the use of the chi-square test. All statistical tests were two-tailed. Analysis was performed on the basis of the intention-to-treat principle.
The study was designed by Drs. Toff, Skehan, and Camm and David de Bono in collaboration with the trial steering committee and other participating investigators (see the Appendix) and funded by the Medical Research Council of the United Kingdom. Pacemakers were purchased according to normal practice, but in centers that had previously implanted less than 50 percent dual-chamber pacing systems, additional hardware costs were met by a subsidy from pacemaker manufacturers and suppliers under the terms of an agreement with the International Association of Prosthesis Manufacturers. No pacemaker manufacturer or supplier had any involvement in the study design, data collection, analysis of results, or writing of the manuscript. The manuscript was written by the principal investigators and the first draft reviewed by the trial steering committee and other participating investigators.
Results
Screening
During the recruitment period, 16,375 patients received a first pacemaker implantation at the participating centers. Of these, 5308 (32.4 percent) had high-grade atrioventricular block and were 70 years of age or more. Exclusion criteria were documented in 945 patients, leaving 4363 eligible for the study, of whom 1972 (45.2 percent) were enrolled. The remaining patients were excluded because the patient declined to participate (13.2 percent), because the physician declined (15.0 percent), or for other or unstated reasons (26.6 percent). Forty-nine patients who were enrolled were not included in the registry either because they did not receive a pacemaker or because registry data were missing for the relevant period.
Treatment Assignment
Of 2021 patients enrolled, 1009 were randomly assigned to receive single-chamber pacing and 1012 to receive dual-chamber pacing. In the single-chamber group, 504 were assigned to fixed-rate pacing and 505 to rate-adaptive pacing. Of those assigned to single-chamber pacing, 99.4 percent received a single-chamber system, 0.2 percent received a dual-chamber system, and 0.4 percent received no pacemaker. Of those assigned to dual-chamber pacing, 95.8 percent received a dual-chamber system, 3.6 percent received a single-chamber system, and 0.6 percent received no pacemaker.
At hospital discharge, the programmed mode of pacing was documented for 99 percent of the patients enrolled. At least 98.9 percent of those assigned to single-chamber pacing were being paced in a single-chamber mode, and at least 95.2 percent of those assigned to dual-chamber pacing were being paced in a dual-chamber mode. At the final follow-up or at the study end point, at least 96.9 percent of the patients assigned to single-chamber pacing were receiving this type of pacing, and at least 91.7 percent of those assigned to dual-chamber pacing were being paced in a dual-chamber mode. At the conclusion of the study, 3.1 percent of patients had crossed over from single-chamber to dual-chamber pacing, primarily because of suspected intolerance of the pacing mode.
The extent of ventricular pacing, as assessed from the pacemaker's memory at one month, was recorded for 65 percent of all patients. The median percentage of ventricular beats that were paced was 94 percent in the fixed-rate single-chamber group, 93 percent in the rate-adaptive single-chamber group, and 99 percent in the dual-chamber group. The difference in ventricular paced beats between the single-chamber group and the dual-chamber group was statistically significant (P<0.001), but the difference between fixed-rate and rate-adaptive single-chamber pacing was not (P=0.85).
Baseline Characteristics
The treatment groups were well balanced with regard to baseline demographic and clinical characteristics (Table 1Table 1
Baseline Demographic and Clinical Characteristics of the Patients.). The mean age of the patients was 79.9 years; 57 percent were male. The indication for pacing was second-degree atrioventricular block in 26.1 percent of patients and complete atrioventricular block in 73.3 percent. Bradycardia was judged as constant in 61.3 percent of patients and intermittent in 38.2 percent. Eighty-three percent of patients were symptomatic.Outcome Events
The median follow-up period was 4.6 years for death and 3 years for other cardiovascular events. No patients were lost to follow-up with respect to the primary end point. Figure 1Figure 1
Cumulative Risk of Death from All Causes and from Cardiovascular Causes According to the Mode of Pacing. shows Kaplan–Meier estimates of the cumulative risk of death from all causes and from cardiovascular causes in the two treatment groups, and Figure 2Figure 2Cumulative Risk of Cardiovascular Events According to the Mode of Pacing. shows estimates for the risk of the specified cardiovascular events. Table 2Table 2
Event Rates and Hazard Ratios for Death from All Causes, Death from Cardiovascular Causes, and Specified Cardiovascular Outcomes in the Pacing Groups. shows event rates and hazard ratios for death from all causes, death from cardiovascular causes, and specified cardiovascular events for the primary comparison of single-chamber pacing with dual-chamber pacing; also shown are the event rates and hazard ratios for the separate comparison of fixed-rate and rate-adaptive single-chamber pacing with dual-chamber pacing.Mortality
The mean annual rate of death from all causes during the first five years after pacemaker implantation was 7.2 percent in the single-chamber group and 7.4 percent in the dual-chamber group (P=0.56). The mean annual rate of death due to cardiovascular causes was 3.9 percent in the single-chamber group and 4.5 percent in the dual-chamber group (P=0.07).
Atrial Fibrillation
There was a higher incidence of atrial fibrillation in the dual-chamber group during the first 18 months after pacemaker implantation but no significant difference in the mean annual event rates at 3 years, which were 3.0 percent in the single-chamber group and 2.8 percent in the dual-chamber group (P=0.74).
Stroke, Transient Ischemic Attack, or Thromboembolism
For the combined outcome of stroke, transient ischemic attack, or thromboembolism, the mean annual event rate was 2.1 percent in the single-chamber group and 1.7 percent in the dual-chamber group (P=0.20). There was a significantly higher event rate with fixed-rate single-chamber pacing (2.5 percent per year) than with dual-chamber pacing (P=0.04), but the event rate in the rate-adaptive single-chamber group (1.7 percent per year) was the same as that in the dual-chamber group (P=0.93).
Heart Failure, Angina, and Myocardial Infarction
There was no significant difference in the mean annual event rate for heart failure, which was 3.2 percent in the single-chamber group and 3.3 percent in the dual-chamber group (P=0.80). Similarly, there was no significant difference between the single-chamber and dual-chamber groups in event rates for new-onset angina or ischemic heart disease or for myocardial infarction.
Subgroup Analysis
The subgroup analysis showed that the presence or absence of selected baseline characteristics did not affect the influence of the pacing mode on the primary end point (Figure 3Figure 3
Effect of Pacing Mode on Deaths from All Causes, According to Subgroups.).Complications
Procedural complications were more common in the dual-chamber group than in the single-chamber group (7.8 percent vs. 3.5 percent, P<0.001), as were other complications before discharge (10.4 percent vs. 6.1 percent, P<0.001). The need for therapeutic intervention was also more frequent in the dual-chamber group (8.8 percent vs. 5.6 percent, P=0.005), as were complications requiring repeated operation before discharge (4.2 percent vs. 2.5 percent, P=0.04). The differences in complication rates were principally due to problems with the placement or stability of atrial leads.
Discussion
The key finding from this randomized trial was that in elderly patients with high-grade atrioventricular block, dual-chamber pacing provided no survival advantage over single-chamber pacing. This result contrasts with the findings of nonrandomized studies that suggested there was improved survival with dual-chamber pacing, which probably reflected selection bias.6,14
Our trial focused on atrioventricular block in the elderly, but the absence of a survival advantage for dual-chamber pacing is consistent with the results of other trials that included younger patients and those with sinus-node disease. In the Pacemaker Selection in the Elderly (PASE) study, 407 patients 65 years of age or older with sinus-node disease or atrioventricular block were randomly assigned to receive single-chamber ventricular pacing or dual-chamber pacing.15 The study was not powered to assess mortality, but there was no significant difference in survival or clinical outcomes during the mean follow-up period of 18 months, although the crossover rate from ventricular to dual-chamber pacing was high (26 percent).
In the Canadian Trial of Physiologic Pacing (CTOPP), 2568 patients 18 years of age or older who had sinus-node disease or atrioventricular block were randomly assigned to physiologic (atrial or dual-chamber) pacing or single-chamber ventricular pacing.16 During the mean follow-up period of three years, there was no significant difference in the rate of death from all causes or in the primary end point of cardiovascular death or stroke. There was an 18 percent reduction in the relative risk of atrial fibrillation with dual-chamber pacing but no significant difference in the rate of hospitalization for heart failure or in the occurrence of stroke. Follow-up extended to a mean of 6.4 years showed a further reduction in the relative risk of atrial fibrillation (20.1 percent) but no other benefit from physiological pacing.17
The absence of a reduction in atrial fibrillation with dual-chamber pacing in the UKPACE trial contrasts with the findings of the CTOPP trial. This difference may reflect the older age of our patients, in whom any propensity toward atrial fibrillation might be less readily influenced by pacing mode. Although the CTOPP trial included patients with sinus-node disease, the reduction in atrial fibrillation with physiologic pacing was also seen in the subgroup with atrioventricular block.18 In the CTOPP trial, the difference in the incidence of atrial fibrillation emerged only at two years. It is possible that with longer follow-up of our patients, a difference might also emerge among them.
An interesting feature in our study was the increased early incidence of atrial fibrillation in the dual-chamber group. It is possible that the atrial lead may be arrhythmogenic in the early months after implantation. Alternatively, the capacity of dual-chamber pacemakers to detect high-rate atrial episodes might have led to an earlier recognition of atrial fibrillation. This capability might also increase the overall likelihood that atrial fibrillation will be detected with these systems, potentially masking a benefit of dual-chamber pacing; however, the diagnostic requirement of an electrocardiographically verified episode lasting 15 minutes or longer would be expected to attenuate the effect of such a bias.
The finding that there was a higher rate of stroke, transient ischemic attack, or thromboembolism with fixed-rate ventricular pacing is intriguing. Conceivably, the lower heart rates associated with fixed-rate pacing might promote atrial stasis, but the finding could be due to the play of chance amid multiple comparisons and should be interpreted with caution. The observation may, however, favor the use of a rate-adaptive system if a single-chamber ventricular pacemaker is used.
Our results, supported by the PASE and CTOPP trials, suggest that the clinical benefits associated with dual-chamber pacing for atrioventricular block have been overestimated. It is perhaps counterintuitive that the hemodynamic advantages of atrioventricular synchrony do not result in greater clinical benefit. One explanation for this may be that intraventricular and interventricular dyssynchrony resulting from stimulation at the right ventricular apex might counteract the benefit of atrioventricular synchrony.19,20 This effect might be accentuated by the higher proportion of paced ventricular beats in the dual-chamber group. It is possible that alternative strategies, such as biventricular or septal pacing, might improve hemodynamic function and clinical outcomes. This hypothesis requires testing in clinical trials.
The low crossover rate (3.1 percent) from single-chamber to dual-chamber pacing in our study was similar to that in the CTOPP trial (2.7 percent), suggesting that single-chamber pacing is well tolerated. The higher crossover rate in the PASE study (26 percent), in which randomization to mode of pacing was made by software programming rather than by assignment of hardware, may reflect variation in the incidence of pacemaker syndrome but also highlights the subjective element in the diagnosis of this syndrome.
The choice of pacing mode for elderly patients with high-grade atrioventricular block should be made on an individual basis. Over three years, dual-chamber pacing is unlikely to influence mortality or the incidence of cardiovascular events, and single-chamber ventricular pacing should be regarded as an acceptable mode. The occasional need to upgrade to dual-chamber systems because of pacing-mode intolerance must be weighed against the increased risk of complications with dual-chamber implants. In elderly patients, factors other than the mode of pacing are more likely to determine the clinical outcome.
In elderly patients with high-grade atrioventricular block, the mode of pacing has no significant influence on the rate of death from all causes in the first five years after pacemaker implantation. Fixed-rate single-chamber ventricular pacing is associated with an increased risk of stroke, transient ischemic attack, or thromboembolism, but the pacing mode does not otherwise influence the incidence of cardiovascular events in the first three years after pacemaker implantation.
Supported by a grant from the Medical Research Council of the United Kingdom (G9403190). Dr. Camm holds a chair funded by the British Heart Foundation. In centers that had previously implanted less than 50 percent dual-chamber pacing systems, additional hardware costs were met by a subsidy from the following pacemaker manufacturers and suppliers under an agreement with the International Association of Prosthesis Manufacturers: Biotronik, Cardiocare, CPI–Guidant, ELA Medical, Intermedics, Medtronic, St. Jude Medical, Sorin Biomedica, Telectronics, and Vitatron.
International Standard Randomized Controlled Trial No. 37445539.
Dr. Toff reports having received lecture fees from St. Jude Medical. Dr. Skehan reports having received consulting fees and having served on the advisory board for Medtronic. Dr. Camm reports having received consulting fees and having served on advisory boards for Guidant, St. Jude Medical, and Vitatron and having received lecture fees from St. Jude Medical and Vitatron.
This article is dedicated to the patients who participated in the trial and to the memory of Prof. David de Bono, coprincipal investigator, who died on April 29, 1999.
We are indebted to the many technical, medical, nursing, and clerical staff members who provided support at the participating centers.
Source Information
From the Department of Cardiovascular Sciences, University of Leicester (W.D.T.), and the Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital (W.D.T., J.D.S.), Leicester, United Kingdom; and the Division of Cardiac and Vascular Sciences, St George's University of London, London (A.J.C.).
Address reprint requests to Dr. Toff at the Department of Cardiovascular Sciences, University of Leicester, Clinical Sciences Wing, Glenfield Hospital, Groby Rd., Leicester LE3 9QP, United Kingdom, or at w.toff@le.ac.uk.
Other participating investigators are listed in the Appendix.
Appendix
The following institutions and investigators participated in the UKPACE trial (total numbers of patients recruited are indicated in parentheses): Glenfield Hospital, Leicester (343) — J.D. Skehan, W.D. Toff, J. Villanueva, J. Kovac, K. Percy, and G.H. Broomes; Freeman Hospital, Newcastle (170) — R.S. Bexton, S. Henderson, and J. Cronin; St George's Hospital, London (154) — A.J. Camm, E. Rowland, D.E. Ward, and S. Jones; Cardiothoracic Centre, Liverpool (139) — R.G. Charles, J. Morland-Duff, and S. Hughes; Queen Elizabeth Hospital, Birmingham (120) — M.D. Gammage, D. Jones, A. Barber, and Z. Harris; Derbyshire Royal Infirmary, Derby (79) — A. McCance and J.E. Penrice; Northern General Hospital, Sheffield (72) — R.J. Bowes and R. Ecob; Blackpool Victoria Hospital, Blackpool (71) — G.K. Goode and A. Delaney; Hull Royal Infirmary, Hull (68) — G.C. Kaye and T. Houghton; Treliske Hospital, Truro (64) — A.K.B. Slade and F. Westwood; University Hospital of Wales, Cardiff (60) — M.B. Buchalter and C. McCormack; John Radcliffe Hospital, Oxford (52) — O.J.M. Ormerod, K. Johnston, and Y. Bashir; UCH/Middlesex Hospitals, London (50) — D. Holdright, R.H. Swanton, and M. Squirrell; Queen's Medical Centre, Nottingham (49) — R.G. Wilcox and S. Jones; Royal Devon and Exeter Hospital, Exeter (45) — J.W. Dean and S. Crowsley; Ninewells Hospital, Dundee (39) — T.H. Pringle and D. Jamieson; Wessex Cardiothoracic Centre, Southampton (39) — J.M. Morgan and R. Williams; Solihull Hospital, Solihull (39) — K. Priestley and P. Brennan; Wordsley Hospital, Stourbridge (35) — E.J. Flint, P. Forsey, and A. Drewnicki; Good Hope Hospital, Sutton Coldfield (30) — R.E.A. Smith and J. Tipping; Derriford Hospital, Plymouth (29) — C.J. Burrell and I. Lines; Southern General Hospital, Glasgow (26) — D. Murdoch and C. Vaughan; Ipswich Hospital, Ipswich (24) — R.M. Oliver and C.J. Woollard; St. Bartholomew's Hospital, London (24) — A.W. Nathan and J. Sibley; Papworth Hospital, Cambridge (23) — M.C. Petch and S. Newell; Western Infirmary, Glasgow (22) — J.D. McArthur and S. Starkey; Nottingham City Hospital, Nottingham (20) — A.J. Ahsan and J. Riley; County Hospital, Hereford (16) — J. Glancy and D. Thomas; Stobhill Hospital, Glasgow (14) — K.J. Hogg and Y. Brown; Stafford General Hospital, Stafford (12) — P.A. Woodmansey and M. Batthew; Royal Sussex County Hospital, Brighton (12) — S. O'Nunain and L. Bennett; Manor Hospital, Walsall (11) — A. Cunnington and C. Boden; New Cross Hospital, Wolverhampton (10) — J.W. Pidgeon and K. Nicholas; Glasgow Royal Infirmary, Glasgow (9) — S.M. Cobbe and C. Armour; Hairmyres Hospital, East Kilbride (7) — K. Oldroyd, B. Vallance, and J. Young; Glan Clywd Hospital, Bodelwyddan (6) — G.J. Green and N. Waterfield; Maelor Hospital, Wrexham (6) — R.P.W. Cowell and M.E. Antony; The General Infirmary, Leeds (5) — G.W. Reynolds and A. Nicholls; Royal Free Hospital, London (5) — J.G. Coghlan and W. Smith; St Mary's Hospital, London (4) — N.S. Peters and J. Varghese; Sandwell Hospital, West Bromwich (4) — P.J. Cadigan and A. Ridney; Wansbeck General Hospital, Ashington (4) — B. Thwaites and J. Cronin; Beaumont Hospital, Dublin (3) — T. Gumbrielle and J. Bedford; City Hospital, Birmingham (3) — T. Millane; Doncaster Royal Infirmary, Doncaster (3) — G.E. Payne and V. Hayward; Heartlands Hospital, Birmingham (1) — P. Ludman, J.M. Beattie, and S. Ramzan: Trial Steering Committee — S.M. Cobbe (chair), S.G. Ball, J.M. Bland, M.J. Buxton, and R. Sutton; Data Monitoring Committee — P. Sleight (chair), R.J.C. Hall, S.J. Pocock, and P.A. Poole-Wilson; End Points and Events Committee — M.C. Petch (chair), M.B. Buchalter, C.J. Burrell, J.C. Cowan, M.D. Gammage, R.T. Johnston, A.N. Sulke, and G.S. Venables; Data Management Center (Nottingham Clinical Research Group) — A.M. Skene (director), L. Brown, A. Charlesworth, M. Goulder, J. Sprague, and S. Stead.
- References
References
1
Gregoratos G ,Cheitlin MD ,Conill A , et al. ACC/AHA guidelines for implantation of cardiac pacemakers and antiarrhythmia devices: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Pacemaker Implantation). J Am Coll Cardiol 1998;31:1175-1209
CrossRef | Web of Science | Medline2
Kruse I ,Arnman K ,Conradson TB ,Ryden L . A comparison of the acute and long-term hemodynamic effects of ventricular inhibited and atrial synchronous ventricular inhibited pacing. Circulation 1982;65:846-855
CrossRef | Web of Science | Medline3
Boon NA ,Frew AJ ,Johnston JA ,Cobbe SM . A comparison of symptoms and intra-arterial ambulatory blood pressure during long term dual chamber atrioventricular synchronous (DDD) and ventricular demand (VVI) pacing. Br Heart J 1987;58:34-39
CrossRef | Web of Science | Medline4
Lau CP ,Wong CK ,Leung WH ,Liu WX . Superior cardiac hemodynamics of atrioventricular synchrony over rate responsive pacing at submaximal exercise: observations in activity sensing DDDR pacemakers. Pacing Clin Electrophysiol 1990;13:1832-1837
CrossRef | Web of Science | Medline5
Tang CY ,Kerr CR ,Connolly SJ . Clinical trials of pacing mode selection. Cardiol Clin 2000;18:1-23
CrossRef | Medline6
Lamas GA ,Pashos CL ,Normand SLT ,McNeil B . Permanent pacemaker selection and subsequent survival in elderly Medicare pacemaker recipients. Circulation 1995;91:1063-1069
Web of Science | Medline7
Clarke M ,Sutton R ,Ward D , et al. Recommendations for pacemaker prescription for symptomatic bradycardia: report of a working party of the British Pacing and Electrophysiology Group. Br Heart J 1991;66:185-191
CrossRef | Web of Science | Medline8
Petch MC . Who needs dual chamber pacing? BMJ 1993;307:215-216
CrossRef | Web of Science | Medline9
Payne GE ,Skehan JD . Issues in cardiac pacing: can agism be justified? Br Heart J 1994;72:102-103
CrossRef | Web of Science | Medline10
Toff WD ,Skehan JD ,De Bono DP ,Camm AJ . The United Kingdom Pacing and Cardiovascular Events (UKPACE) trial. Heart 1997;78:221-223
Web of Science | Medline11
Kaplan EL ,Meier P . Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457-481
CrossRef | Web of Science12
Cox DR . Regression models and life-tables. J R Stat Soc [B] 1972;34:187-22013
Peto R ,Pike MC ,Armitage P , et al. Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. Analysis and examples. Br J Cancer 1977;35:1-39
CrossRef | Web of Science | Medline14
Jahangir A ,Shen WK ,Neubauer SA , et al. Relation between mode of pacing and long-term survival in the very elderly. J Am Coll Cardiol 1999;33:1208-1216
CrossRef | Web of Science | Medline15
Lamas GA ,Orav EJ ,Stambler BS , et al. Quality of life and clinical outcomes in elderly patients treated with ventricular pacing as compared with dual-chamber pacing. N Engl J Med 1998;338:1097-1104
Full Text | Web of Science | Medline16
Connolly SJ ,Kerr CR ,Gent M , et al. Effects of physiologic pacing versus ventricular pacing on the risk of stroke and death due to cardiovascular causes. N Engl J Med 2000;342:1385-1391
Full Text | Web of Science | Medline17
Kerr CR ,Connolly SJ ,Abdollah H , et al. Canadian Trial of Physiological Pacing: effects of physiological pacing during long-term follow-up. Circulation 2004;109:357-362
CrossRef | Web of Science | Medline18
Skanes AC ,Krahn AD ,Yee R , et al. Progression to chronic atrial fibrillation after pacing: The Canadian Trial of Physiologic Pacing. J Am Coll Cardiol 2001;38:167-172
CrossRef | Web of Science | Medline19
Wilkoff BL ,Cook JR ,Epstein AE , et al. Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA 2002;288:3115-3123
CrossRef | Web of Science | Medline20
Sweeney MO ,Hellkamp AS ,Ellenbogen KA , et al. Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation 2003;107:2932-2937
CrossRef | Web of Science | Medline
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Citing Articles
1
Songwen Chen, Jing Liu, Wenzhi Pan, Shaowen Liu, Yangang Su, Jin Bai, Wei Wang, Junbo Ge. (2012) Thromboembolic Events During the Perioperative Period in Patients Undergoing Permanent Pacemaker Implantation. Clinical Cardiologyn/a-n/a
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J.-J. Perrenoud. (2011) Ethical considerations in geriatric cardiology. European Geriatric Medicine 2:6, 363-370
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P. Mabo, F. Victor, P. Bazin, S. Ahres, D. Babuty, A. Da Costa, D. Binet, J.-C. Daubert, . (2011) A randomized trial of long-term remote monitoring of pacemaker recipients (The COMPAS trial). European Heart Journal
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S. Marchandise, C. Scavee, J.-B. le Polain de Waroux, C. de Meester, J.-L. Vanoverschelde, N. Debbas. (2011) Long-term follow-up of DDD and VDD pacing: a prospective non-randomized single-centre comparison of patients with symptomatic atrioventricular block. Europace
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Honey E Thomas, Michael S Cunnington, Janet M McComb. (2011) Pacing in older people. Reviews in Clinical Gerontology 21:04, 312-330
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Simon Modi, Andrew Krahn, Raymond Yee. (2011) Current Concepts in Pacing 2010–2011: The Right and Wrong Way to Pace. Current Treatment Options in Cardiovascular Medicine 13:5, 370-384
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LUCIANA V. ARMAGANIJAN, WILLIAM D. TOFF, JENS C. NIELSEN, HENNING R. ANDERSEN, STUART J. CONNOLLY, KENNETH A. ELLENBOGEN, JEFF S. HEALEY. (2011) Are Elderly Patients at Increased Risk of Complications Following Pacemaker Implantation? A Meta-Analysis of Randomized Trials. Pacing and Clinical Electrophysiologyno-no
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Mads Brix Kronborg, Peter Thomas Mortensen, Jens Christian Gerdes, Henrik Kjaerulf Jensen, Jens Cosedis Nielsen. (2011) His and para-His pacing in AV block: feasibility and electrocardiographic findings. Journal of Interventional Cardiac Electrophysiology 31:3, 255-262
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Douglas HJ Elder, Chim C Lang, Anna Maria Choy. (2011) Pacing-induced heart disease: understanding the pathophysiology and improving outcomes. Expert Review of Cardiovascular Therapy 9:7, 877-886
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Fernando Cabrera-Bueno, Javier Alzueta, María José Molina Mora, Alberto Barrera, José Peña, Julia Fernández Pastor, Antonio Linde Estrella. (2011) Efecto de la estimulación ventricular derecha permanente sobre la geometría y la función ventricular, y los niveles de péptido natriurético cerebral (diseño del Estudio Apex). Cardiocore 46:3, e28-e32
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Antonio F Folino, Roberto Breda, Patrizia Calzavara, Federico Migliore, Sabino Iliceto, Gianfranco Buja. (2011) In-home controls of pacemakers in debilitated elderly patients. Geriatrics & Gerontology Internationalno-no
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PETER PAUL HM DELNOY, JAN PAUL OTTERVANGER, DICK HS VOS, ARIF ELVAN, ANAND R RAMDAT MISIER, WILLEM P BEUKEMA, PAUL STEENDIJK, NORBERT M VAN HEMEL. (2011) Upgrading to Biventricular Pacing Guided by Pressure-Volume Loop Analysis During Implantation. Journal of Cardiovascular Electrophysiology 22:6, 677-683
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J. C. Nielsen, P. E. B. Thomsen, S. Hojberg, M. Moller, T. Vesterlund, D. Dalsgaard, L. S. Mortensen, T. Nielsen, M. Asklund, E. V. Friis, P. D. Christensen, E. H. Simonsen, U. H. Eriksen, G. V. H. Jensen, J. H. Svendsen, W. D. Toff, J. S. Healey, H. R. Andersen, . (2011) A comparison of single-lead atrial pacing with dual-chamber pacing in sick sinus syndrome. European Heart Journal 32:6, 686-696
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I. Savelieva, N. Kakouros, A. Kourliouros, A. J. Camm. (2011) Upstream therapies for management of atrial fibrillation: review of clinical evidence and implications for European Society of Cardiology guidelines. Part I: primary prevention. Europace 13:3, 308-328
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Wai Kah Choo, Sandeep Gupta. (2011) The impact of NICE (UK) recommendations on outcomes of cardiac pacemaker implantations - a single-centre, district hospital experience. Journal of Evaluation in Clinical Practiceno-no
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Bruce S. Stambler, Kenneth A. Ellenbogen. 2011. Pacing for Atrioventricular Conduction System Disease. , 323-360.
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Anne M. Gillis. 2011. Pacing for Sinus Node Disease. , 300-322.
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JIH-MIN LIN, LING-PING LAI, CHIH-SHENG LIN, NAI-KUAN CHOU, CHIH-YUAN CHIU, JIUNN-LEE LIN. (2010) Left Ventricular Extracellular Matrix Remodeling in Dogs with Right Ventricular Apical Pacing. Journal of Cardiovascular Electrophysiology 21:10, 1142-1149
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Stavroula N. Psychari, Thomas S. Apostolou, Efstathios K. Iliodromitis, Athanasios Charalampopoulos, Dimitrios T. Kremastinos. (2010) DDDR pacing results in left ventricular asynchrony with preservation of ejection fraction and NT-proBNP: A prospective study in sick sinus syndrome and normal ventricular function. International Journal of Cardiology 144:2, 310-312
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SANA OUALI, ELYES NEFFETI, KARIMA GHOUL, SAMI HAMMAS, SLIM KACEM, RIM GRIBAA, FAHMI REMEDI, ESSIA BOUGHZELA. (2010) DDD versus VVIR Pacing in Patients, Ages 70 and Over, with Complete Heart Block. Pacing and Clinical Electrophysiology 33:5, 583-589
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R. Barba-Pichardo, P. Morina-Vazquez, J. M. Fernandez-Gomez, J. Venegas-Gamero, M. Herrera-Carranza. (2010) Permanent His-bundle pacing: seeking physiological ventricular pacing. Europace 12:4, 527-533
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A. Proclemer, M. Ghidina, D. Gregori, D. Facchin, L. Rebellato, E. Zakja, M. Gulizia, P. Esente. (2010) Trend of the main clinical characteristics and pacing modality in patients treated by pacemaker: data from the Italian Pacemaker Registry for the quinquennium 2003-07. Europace 12:2, 202-209
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Won Ho Kim, Boyoung Joung, Jaemin Shim, Jong Sung Park, Eui-Seock Hwang, Hui-Nam Pak, Sungsoon Kim, Moonhyoung Lee. (2010) Long-Term Outcome of Single-Chamber Atrial Pacing Compared with Dual-Chamber Pacing in Patients with Sinus-Node Dysfunction and Intact Atrioventricular Node Conduction. Yonsei Medical Journal 51:6, 832
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J. Silberbauer, R. A. Veasey, N. Freemantle, A. Arya, L. Boodhoo, N. Sulke. (2009) The relationship between high-frequency right ventricular pacing and paroxysmal atrial fibrillation burden. Europace 11:11, 1456-1461
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MITHILESH K. DAS, GOPI DANDAMUDI, HILLEL A. STEINER. (2009) Modern Pacemakers: Hope or Hype?. Pacing and Clinical Electrophysiology 32:9, 1207-1221
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DRITAN POÇI, LOTTA BACKMAN, THOMAS KARLSSON, NILS EDVARDSSON. (2009) New or Aggravated Heart Failure during Long-Term Right Ventricular Pacing after AV Junctional Catheter Ablation. Pacing and Clinical Electrophysiology 32:2, 209-216
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José Martínez Ferrer, María L. Fidalgo Andrés, Rafael Barba Pichardo, María J. Sancho-Tello de Carranza. (2009) Novedades en estimulación cardiaca. Revista Española de Cardiología 62, 117-128
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P. P. H.M. Delnoy, J. P. Ottervanger, H. O. Luttikhuis, D. H.S. Vos, A. Elvan, A. R. Ramdat Misier, W. P. Beukema, P. Steendijk, N. M. van Hemel. (2008) Pressure-volume loop analysis during implantation of biventricular pacemaker/cardiac resynchronization therapy device to optimize right and left ventricular pacing sites. European Heart Journal 30:7, 797-804
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Carsten W. Israel. (2008) „Sandwiched“ zwischen Ein- und Dreikammer-ICD: Brauchen wir den Zweikammer-ICD überhaupt noch?. Herzschrittmachertherapie + Elektrophysiologie 19:S1, 14-24
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MICHAEL O SWEENEY, ANNE S HELLKAMP, KENNETH A ELLENBOGEN, GERVASIO A LAMAS. (2008) Reduced Ejection Fraction, Sudden Cardiac Death, and Heart Failure Death in the Mode Selection Trial (MOST): Implications for Device Selection in Elderly Patients with Sinus Node Disease. Journal of Cardiovascular Electrophysiology 19:11, 1160-1166
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K. Kaszala, J. F. Huizar, K. A. Ellenbogen. (2008) Contemporary Pacemakers: What the Primary Care Physician Needs to Know. Mayo Clinic Proceedings 83:10, 1170-1186
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BRUNA G. OLIVEIRA, GUSTAVO VELASQUEZ-MELENDEZ, LEONOR G. RINCÓN, ROZANA M. CICONELLI, LIDIANE A. SOUSA, ANTONIO L. RIBEIRO. (2008) Health-Related Quality of Life in Brazilian Pacemaker Patients. Pacing and Clinical Electrophysiology 31:9, 1178-1183
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Chung-Wah Siu, Mei Wang, Xue-Hua Zhang, Chu-Pak Lau, Hung-Fat Tse. (2008) Analysis of Ventricular Performance as a Function of Pacing Site and Mode. Progress in Cardiovascular Diseases 51:2, 171-182
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TAKUO TSURUGI, HARUHIKO ABE, YASUSHI OGINOSAWA, RITSUKO KOHNO, TOMIYA YASUMASU, TOSHIHISA NAGATOMO, YUTAKA OTSUJI. (2008) Effects of Pacing Modes on Cardiac Baroreflex Function in Permanently Paced Patients with Sinus Node Dysfunction. Journal of Cardiovascular Electrophysiology 19:7, 702-707
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Andrew E. Epstein, John P. DiMarco, Kenneth A. Ellenbogen, N. A. Mark Estes, Roger A. Freedman, Leonard S. Gettes, A. Marc Gillinov, Gabriel Gregoratos, Stephen C. Hammill, David L. Hayes, Mark A. Hlatky, L. Kristin Newby, Richard L. Page, Mark H. Schoenfeld, Michael J. Silka, Lynne Warner Stevenson, Michael O. Sweeney, Sidney C. Smith, Alice K. Jacobs, Cynthia D. Adams, Jeffrey L. Anderson, Christopher E. Buller, Mark A. Creager, Steven M. Ettinger, David P. Faxon, Jonathan L. Halperin, Loren F. Hiratzka, Sharon A. Hunt, Harlan M. Krumholz, Frederick G. Kushner, Bruce W. Lytle, Rick A. Nishimura, Joseph P. Ornato, Richard L. Page, Barbara Riegel, Lynn G. Tarkington, Clyde W. Yancy. (2008) ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities. Heart Rhythm 5:6, e1-e62
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C. M. Fored, F. Granath, F. Gadler, P. Blomqvist, J. Rynder, C. Linde, A. Ekbom, M. Rosenqvist. (2008) Atrial vs. dual-chamber cardiac pacing in sinus node disease: a register-based cohort study. Europace 10:7, 825-831
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Andrew E. Epstein, John P. DiMarco, Kenneth A. Ellenbogen, N.A. Mark Estes, Roger A. Freedman, Leonard S. Gettes, A. Marc Gillinov, Gabriel Gregoratos, Stephen C. Hammill, David L. Hayes, Mark A. Hlatky, L. Kristin Newby, Richard L. Page, Mark H. Schoenfeld, Michael J. Silka, Lynne Warner Stevenson, Michael O. Sweeney. (2008) ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities. Journal of the American College of Cardiology 51:21, e1-e62
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G. Fröhlig, M. Kindermann. (2008) HIS-Bündel-Stimulation und alternative rechtsventrikuläre Stimulationsorte. Herzschrittmachertherapie + Elektrophysiologie 19:1, 30-40
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XUE-HUA ZHANG, HUA CHEN, CHUNG-WAH SIU, KAI-HANG YIU, WING-SZE CHAN, KATHY L. LEE, HON-WAH CHAN, STEPHEN W. LEE, GUO-SHENG FU, CHU-PAK LAU, HUNG-FAT TSE. (2008) New-Onset Heart Failure After Permanent Right Ventricular Apical Pacing in Patients with Acquired High-Grade Atrioventricular Block and Normal Left Ventricular Function. Journal of Cardiovascular Electrophysiology 19:2, 136-141
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Paolo Busacca, Giuliano Gheller, Mauro Pupita, Giovanni Berzigotti, Carlo Alberto Generali, Sandro De Crescentini, Paolo Gerardi, Alberto Agostini, Claudio Frattini, Giorgio Corbucci, Stefano Papi. (2008) Long-term follow-up of patients paced in VDD mode for advanced atrioventricular block: a pilot study. Journal of Cardiovascular Medicine 9:1, 39-42
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Beat Andreas Schaer, Markus Weinbacher, Michael Johannes Zellweger, Christian Sticherling, Stefan Osswald. (2007) Value of VDD-pacing systems in patients with atrioventricular block: Experience over a decade. International Journal of Cardiology 122:3, 239-243
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LIN CHEN, DAVID HODGE, ARSHAD JAHANGIR, CEVHER OZCAN, JANE TRUSTY, PAUL FRIEDMAN, ROBERT REA, DAVID BRADLEY, PETER BRADY, STEPHEN HAMMILL, DAVID HAYES, WIN-KUANG SHEN. (2007) Preserved Left Ventricular Ejection Fraction Following Atrioventricular Junction Ablation and Pacing for Atrial Fibrillation. Journal of Cardiovascular Electrophysiology 0:0, 071027163406006-???
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Sweeney, Michael O., Bank, Alan J., Nsah, Emmanuel, Koullick, Maria, Zeng, Qian Cathy, Hettrick, Douglas, Sheldon, Todd, Lamas, Gervasio A., . (2007) Minimizing Ventricular Pacing to Reduce Atrial Fibrillation in Sinus-Node Disease. New England Journal of Medicine 357:10, 1000-1008
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Mark H. Schoenfeld. (2007) Rate-modulated pacing: Are we adept at determining what is physiologic?. Heart Rhythm 4:9, 1133-1135
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Dwight W. Reynolds, Christina M. Murray. (2007) New concepts in physiologic cardiac pacing. Current Cardiology Reports 9:5, 351-357
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A. Markewitz, . (2007) Jahresbericht 2005 des Deutschen Herzschrittmacher-Registers. Herzschrittmachertherapie & Elektrophysiologie 18:3, 166-193
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JEFFREY WING-HONG FUNG, JOSEPH YAT-SUN CHAN, RAZALI OMAR, AZLAN HUSSIN, QING ZHANG, GABRIEL YIP, KAI HUAT LAM, FANG FANG, CHEUK-MAN YU. (2007) The Pacing to Avoid Cardiac Enlargement (PACE) Trial: Clinical Background, Rationale, Design, and Implementation. Journal of Cardiovascular Electrophysiology 18:7, 735-739
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Uta C. Hoppe. (2007) Resynchronization therapy in the context of atrial fibrillation: Benefits and limitations. Journal of Interventional Cardiac Electrophysiology 18:3, 225-232
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John Silberbauer, Neil Sulke. (2007) The role of pacing in rhythm control and management of atrial fibrillation. Journal of Interventional Cardiac Electrophysiology 18:2, 159-186
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Teresa Pareja Sierra, Jorge Castro Dorticós, María Paz Jiménez Jiménez, Javier Balaguer Recena. (2007) Paciente anciano portador de marcapasos: Características y evolución en función del tipo de dispositivo empleado. Revista Española de Geriatría y Gerontología 42:3, 149-157
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Jeff S Healey, Raymond Yee, Anthony Tang. (2007) Right ventricular apical pacing: a necessary evil?. Current Opinion in Cardiology 22:1, 33-38
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Marcelle D. Smit, Pascal F.H.M. Van Dessel, Wybe Nieuwland, Ans C.P. Wiesfeld, Eng S. Tan, Rutger L. Anthonio, Lieselot Van Erven, Dirk J. Van Veldhuisen, Isabelle C. Van Gelder. (2006) Right ventricular pacing and the risk of heart failure in implantable cardioverter-defibrillator patients. Heart Rhythm 3:12, 1397-1403
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Nanette K. Wenger. (2006) Enrollment and Maintenance of Elderly Patients in Cardiovascular Clinical Trials. The American Journal of Geriatric Cardiology 15:6, 352-356
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Anne M. Gillis. (2006) Redefining physiologic pacing: Lessons learned from recent clinical trials. Heart Rhythm 3:11, 1367-1372
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Heng Huang, Li Shen, Rong Zhang, Fillia Makedon, Bruce Hettleman, Justin Pearlman. (2006) Cardiac Motion Analysis to Improve Pacing Site Selection in CRT. Academic Radiology 13:9, 1124-1134
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George D. Veenhuyzen. (2006) Cost Advantage of Different Cardioverter-Defibrillator Devices. Journal of the American College of Cardiology 48:2, 418-419
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Anne S. Hellkamp, Kerry L. Lee, Michael O. Sweeney, Mark S. Link, Gervasio A. Lamas. (2006) Treatment Crossovers Did Not Affect Randomized Treatment Comparisons in the Mode Selection Trial (MOST). Journal of the American College of Cardiology 47:11, 2260-2266
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YASUSHI OGINOSAWA, HARUHIKO ABE, TOMIYA YASUMASU, TAKUO TSURUGI, RITSUKO KOHNO. (2006) Comparison of the Effects of VVI Versus DDD Pacing on Cardiac Baroreflex Function. Journal of Cardiovascular Electrophysiology 17:5, 526-531
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CARLOS A. MORILLO. (2006) Cardiac Reflexes During Pacing: Are We Getting to the Heart of the Matter?. Journal of Cardiovascular Electrophysiology 17:5, 532-533
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Mark H. Schoenfeld. (2006) Alternative Site Pacing to Promote Cardiac Synchrony. Journal of the American College of Cardiology 47:10, 1946-1948
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Melvin M. Scheinman, Edmund Keung. (2006) The Year in Clinical Electrophysiology. Journal of the American College of Cardiology 47:6, 1207-1213
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Shane M. Bailey, Bruce L. Wilkoff. (2006) Complications of Pacemakers and Defibrillators in the Elderly. The American Journal of Geriatric Cardiology 15:2, 102-107
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Claudia Martinez, Assaf Tzur, Hakop Hrachian, Joseph Zebede, Gervasio A. Lamas. (2006) Pacemakers and Defibrillators: Recent and Ongoing Studies That Impact the Elderly. The American Journal of Geriatric Cardiology 15:2, 82-87
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Karoly Kaszala, Gautham Kalahasty, Kenneth A. Ellenbogen. (2006) Cardiac Pacing in the Elderly. The American Journal of Geriatric Cardiology 15:2, 77-81
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A.L. Waldo. (2006) Single-Chamber Versus Dual-Chamber Pacing for High-Grade Atrioventricular Block. Yearbook of Cardiology 2006, 449-450
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Michael O. Sweeney, Frits W. Prinzen. (2006) A New Paradigm for Physiologic Ventricular Pacing. Journal of the American College of Cardiology 47:2, 282-288
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Yukiko Sashida, Fumiaki Mori, Hiroyuki Arashi, Fumitaka Hosaka, Tsutomu Itai, Satoshi Ohnishi. (2006) Improvement of Left Ventricular Function by Permanent Direct His-Bundle Pacing in a Case with Dilated Cardiomyopathy. Journal of Arrhythmia 22:4, 245-250
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W FRISHMAN. (2006) Single-Chamber Versus Dual-Chamber Pacing for High-Grade Atrioventricular BlockToff WD, for the United Kingdom Pacing and Cardiovascular Events (UKPACE) Trial Investigators (Univ of Leicester, England; et al) N Engl J Med 353:145–155, 2005§. Yearbook of Medicine 2006, 363-365
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David O Martin. (2005) Single-chamber versus dual-chamber pacing: which is most efficacious in elderly patients with atrioventricular block?. Nature Clinical Practice Cardiovascular Medicine 2:12, 622-623
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G. Fröhlig. (2005) Stellenwert der Herzschrittmacher-Therapie bei der Vorhofflimmer-Prophylaxe. Zeitschrift für Kardiologie 94:S4, iv53-iv59
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Mark A. Hlatky. (2005) Cost Effectiveness of Cardiac Resynchronization Therapy
Editorials published in the Journal of the American College of Cardiology reflect the views of the authors and do not necessarily represent the views of JACC or the American College of Cardiology.. Journal of the American College of Cardiology 46:12, 2322-2324
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(2005) Pacing for Atrioventricular Block. New England Journal of Medicine 353:16, 1742-1744
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Claire Braybrook. (2005) Similar clinical benefits with dual-chamber and single-chamber pacemakers. Nature Clinical Practice Cardiovascular Medicine 2:10, 495-496
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Dennis L. DeSilvey, Dennis L. DeSilvey. (2005) Choice of Pacemaker Mode in High-Grade Heart Block. The American Journal of Geriatric Cardiology 14:5, 271-272
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Ellenbogen, Kenneth A., Wood, Mark A., . (2005) Pacemaker Selection — The Changing Definition of Physiologic Pacing. New England Journal of Medicine 353:2, 202-204
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