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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

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Author(s)
Chu-Pak LauNgarmukos TachapongChun-Chieh WangJing-feng WangHaruhiko AbeChi-Woon KongReginald LiewDong-Gu ShinLuigi PadelettiYou-Ho KimRazali OmarKreingkrai JirarojanakornYoon-Nyun KimMien-Cheng ChenCharn SriratanasathavornMuhammad MunawarRuth KamJan-Yow ChenYong-Keun ChoYi-Gang LiShu-Lin WuChristophe BailleulHung-Fat Tse
Keimyung Author(s)
Kim, Yoon Nyun
Department
Dept. of Internal Medicine (내과학)
Journal Title
Circulation
Issued Date
2013
Volume
128
Issue
7
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.


Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT00419640.
Key Words: atrial fibrillation
cardiac pacing, artificial
sick sinus syndrome
Keimyung Author(s)(Kor)
김윤년
Publisher
School of Medicine
Citation
Chu-Pak Lau et al. (2013). 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. Circulation, 128(7), 687–693. doi: 10.1161/CIRCULATIONAHA.113.001644
Type
Article
ISSN
0009-7322
DOI
10.1161/CIRCULATIONAHA.113.001644
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/35419
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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