(Circulation. 1997;96:260-266.)
© 1997 American Heart Association, Inc.
Articles |
Effects of Permanent Pacemaker and Oral Theophylline in Sick Sinus Syndrome
The THEOPACE Study: A Randomized Controlled Trial
From the Division of Cardiology, Ospedale Civile, Cento (P.A., N.P., R.C.); the Section of Arrhythmology, Department of Cardiology, Ospedale S Maria Nuova, Reggio Emilia (C.M., G.L.); and the Section of Arrhythmology, Department of Cardiology, Ospedali Riuniti, Lavagna (M.B., G.G.), Italy.
Correspondence to Dr Paolo Alboni, Division of Cardiology, Ospedale Civile, 44042 Cento (Fe), Italy.
Background Pacemakers and theophylline are currently being used to relieve symptoms in patients with sick sinus syndrome (SSS). However, the impact of either therapy on the natural course of the disease is unknown. We conducted a randomized controlled trial to prospectively assess the effects of pacemakers and theophylline in patients with SSS.
Methods and Results One hundred seven patients with symptomatic SSS (age, 73±11 years) were randomized to no treatment (control group, n=35), oral theophylline (n=36), or dual-chamber rate-responsive pacemaker therapy (n=36). They were followed for up to 48 months (mean, 19±14 months). During follow-up, the occurrence of syncope was lower in the pacemaker group than in the control group (P=.02) and tended to be lower than in the theophylline group (P=.07). Heart failure occurred less often in patients assigned to pacemaker therapy and theophylline than in control patients (both, P=.05), whereas the incidence of sustained paroxysmal tachyarrhythmias, permanent atrial fibrillation, and thromboembolic events did not show any apparent difference among the three groups. Heart rate was higher in the theophylline group than in the control group. Both pacemaker therapy and theophylline improved symptom scores after 3 months of treatment; however, a similar improvement was observed in the control group.
Conclusions In patients with symptomatic SSS, therapy with theophylline or dual-chamber pacemaker is associated with a lower incidence of heart failure; pacemaker therapy is also associated with a lower incidence of syncope. The therapeutic benefits of pacemakers and theophylline on symptoms are partly a result of spontaneous improvement of the disease.
Key Words: arrhythmia • pacemakers • syncope • theophylline
This article has been cited by other articles:
 |
|
 |
|
  Developed in collaboration with, European Heart Rhythm Association (EHRA), Heart Failure Association (HFA), and Heart Rhythm Society (HRS), Endorsed by the following societies, European Society of Emergency Medicine (EuSEM), European Federation of Internal Medicine (EFIM), European Union Geriatric Medicine Society (EUGMS), American Geriatrics Society (AGS), European Neurological Society (ENS), et al. Guidelines for the diagnosis and management of syncope (version 2009): The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC) Eur. Heart J., November 1, 2009; 30(21): 2631 - 2671. [Full Text] [PDF]
|
|
|
|
 |
|
 P. Alboni, L. Gianfranchi, and M. Brignole Treatment of persistent sinus bradycardia with intermittent symptoms: are guidelines clear? Europace, May 1, 2009; 11(5): 562 - 564. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Brignole, J.-J. Blanc, R. Sutton, and A. Moya CHAPTER 26 Syncope ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Kaszala, J. F. Huizar, and K. A. Ellenbogen Contemporary Pacemakers: What the Primary Care Physician Needs to Know Mayo Clin. Proc., October 1, 2008; 83(10): 1170 - 1186. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. J. Gentlesk, T. T. Markwood, and J. E. Atwood Chronotropic Incompetence in a Young Adult: Case Report and Literature Review Chest, January 1, 2004; 125(1): 297 - 301. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Guidelines on Management (diagnosis and treatment) of syncope - update 2004: The Task Force on Syncope, European Society of Cardiology Europace, January 1, 2004; 6(6): 467 - 537. [Full Text] [PDF]
|
|
|
|
 |
|
 W. H. Lee, J. S. Gounarides, E. S. Roos, and M. S. Wolin Influence of peroxynitrite on energy metabolism and cardiac function in a rat ischemia-reperfusion model Am J Physiol Heart Circ Physiol, October 1, 2003; 285(4): H1385 - H1395. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J M Edelberg, D T Huang, M E Josephson, and R D Rosenberg Molecular enhancement of porcine cardiac chronotropy Heart, November 1, 2001; 86(5): 559 - 562. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Task Force on Syncope, European Society of Cardiol, M Brignole, P Alboni, D Benditt, L Bergfeldt, J.J Blanc, P.E Bloch Thomsen, J.G van Dijk, A Fitzpatrick, S Hohnloser, et al. Guidelines on management (diagnosis and treatment) of syncope Eur. Heart J., August 1, 2001; 22(15): 1256 - 1306. [Abstract] [PDF]
|
|
|
|
|
|
A. R. Panchal, B. Comte, H. Huang, T. Kerwin, A. Darvish, C. D. Rosiers, H. Brunengraber, and W. C. Stanley Partitioning of pyruvate between oxidation and anaplerosis in swine hearts Am J Physiol Heart Circ Physiol, November 1, 2000; 279(5): H2390 - H2398. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F.J. Van de Werf The ideal fibrinolytic: can drug design improve clinical results? Eur. Heart J., October 2, 1999; 20(20): 1452 - 1458. [PDF]
|
|
|
|
|
|
P. Alboni, M. Brignole, C. Menozzi, and S. Scarfo Is sinus bradycardia a factor facilitating overt heart failure? Eur. Heart J., February 2, 1999; 20(4): 252 - 255. [PDF]
|
|