(Circulation. 2001;103:3081.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Relationship Between Pacemaker Dependency and the Effect of Pacing Mode on Cardiovascular Outcomes
From the University of Ottawa Heart Institute, Ottawa, Ontario (A.S.L.T., M.S.G.); McMaster University, Hamilton, Ontario (R.S.R., S.YL, M.G., S.J.C.); the University of British Columbia, Vancouver, British Colombia (C.K.); the University of Calgary, Calgary, Alberta (A.M.G.); Montreal Heart Institute, Montreal, Province of Quebec (M.T.); and Queen’s University, Kingston, Ontario (H.A.), Canada.
Correspondence to Dr Anthony S.L. Tang, University of Ottawa Heart Institute, 40 Ruskin St., Ottawa, Ontario, Canada, K1Y4W7. E-mail atang{at}ottawaheart.ca
Background—A recently completed trial, the Canadian Trial of Physiological Pacing (CTOPP), showed that physiological pacing did not significantly reduce mortality, stroke, or heart failure hospitalization, but it did show that atrial fibrillation occurred less frequently in patients with physiological pacing. Many pacemaker patients experience only transient bradyarrhythmias with an adequate unpaced heart rate (UHR) and are not pacemaker-dependent. The purpose of the present analysis was to determine if pacemaker-dependent patients have an increased benefit from physiological pacing compared with non–pacemaker-dependent patients.
Methods and Results—Of
2568 patients included in the CTOPP trial, 2244 patients had a
pacemaker dependency test performed at the first follow-up visit. The
yearly event rate of cardiovascular death or stroke
steadily increased with decreasing UHR in the ventricular
pacing group, but it remained constant in the
physiological pacing group. When the patients were
subdivided to UHR 
60 bpm or >60 bpm, there was an interaction
between pacing mode treatment and UHR subgroup. The Kaplan-Meier plot
confirmed a physiological pacing advantage only in
the UHR 60 bpm subgroup. This differential effect was also
present for the outcomes of cardiovascular death
and total mortality.
Conclusions—This study demonstrated that UHR at first follow-up has an important influence on how pacing mode selection affects cardiovascular death and total mortality. Pacemaker-dependent patients with low UHR will probably be paced frequently and will likely benefit from physiological pacing. In contrast, non–pacemaker-dependent patients will likely be paced infrequently and may not benefit from physiological pacing.
Key Words: pacemakers • trials • mortality
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