Long-term follow up of single-chamber atrial pacing-system upgrade and Wenckebach block point behavior: potential implications for leadless AAI pacing?

IF 2.1 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Interventional Cardiac Electrophysiology Pub Date : 2025-05-16 DOI:10.1007/s10840-025-02061-4

Patrick Badertscher, Rebecca Arnet, Corinne Isenegger, Behnam Subin, Sven Knecht, Jessica Trussardi, Philipp Krisai, Felix Mahfoud, Christian Sticherling, Beat Schär, Michael Kühne

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引用次数: 0

Abstract

Background: Single chamber atrial pacing (AAI) provides a disease-specific treatment for sick sinus syndrome (SSS) but has largely been replaced by DDD pacing. With the advent of leadless atrial pacemakers (PM), there is growing interest in long-term follow-up data in patients with SSS and an AAI pacemaker.

Purpose: To assess the incidence of system upgrade in patients treated with AAI-PM for SSS during long-term follow-up.

Methods: This is an analysis of prospectively enrolled patients undergoing implantation of an AAI-PM. Wenckebach block point (WBP) was measured at implantation and serially during follow up.

Results: We included 178 patients (58% female, median age at implantation 77 [71-83] years). The median follow-up duration was 6.5 [2.0-9.7] years. Twenty-three patients (13%) received a system upgrade to a DDD system, corresponding to a yearly upgrade rate of 2.0%. Median time to system upgrade was 5.2 [1.6-8.7] years. Reasons for system upgrade were higher-degree AVB (39%), atrial arrhythmias (35%), low WBP (17%), and syncope (9%). Median WBP at implantation was 130 [120-140] bpm, showing a significant decline over time in the upgrade-group compared to the rest of the cohort with 103 [91-130] bpm vs. 130 [120-130] bpm (p = 0.011).

Conclusion: In this cohort of patients undergoing AAI-PM implantation for SSS, upgrade to a DDD system was low during long-term follow-up. Therefore, AAI pacing for the treatment of SSS may be considered a patient-tailored treatment option, especially in light of novel leadless pacing therapies.

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单室心房起搏系统升级和Wenckebach阻滞点行为的长期随访：对无导联心房起搏的潜在影响？

背景：单室心房起搏（AAI）为病窦综合征（SSS）提供了一种疾病特异性治疗，但已在很大程度上被DDD起搏所取代。随着无导联心房起搏器（PM）的出现，人们对SSS和AAI起搏器患者的长期随访数据越来越感兴趣。目的：评估AAI-PM治疗SSS患者在长期随访期间系统升级的发生率。方法：这是一项前瞻性入组患者接受AAI-PM植入的分析。在植入时和随访期间连续测量Wenckebach阻滞点（WBP）。结果：我们纳入178例患者（58%为女性，植入时中位年龄77岁[71-83]）。中位随访时间为6.5年[2.0-9.7]年。23例患者（13%）接受了系统升级至DDD系统，相应的年升级率为2.0%。系统升级的中位时间为5.2[1.6-8.7]年。系统升级的原因是高程度AVB（39%）、心房心律失常（35%）、低WBP（17%）和晕厥（9%）。植入时的中位WBP为130 [120-140]bpm，与其他队列中的103 [91-130]bpm和130 [120-130]bpm相比，升级组随着时间的推移显著下降（p = 0.011）。结论：在这组接受AAI-PM植入治疗SSS的患者中，长期随访期间升级到DDD系统的比例较低。因此，AAI起搏治疗SSS可能被认为是一种针对患者的治疗选择，特别是考虑到新型无导联起搏治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Interventional Cardiac Electrophysiology 医学-心血管系统

CiteScore

4.30

自引率

11.10%

发文量

320

审稿时长

4-8 weeks

期刊介绍： The Journal of Interventional Cardiac Electrophysiology is an international publication devoted to fostering research in and development of interventional techniques and therapies for the management of cardiac arrhythmias. It is designed primarily to present original research studies and scholarly scientific reviews of basic and applied science and clinical research in this field. The Journal will adopt a multidisciplinary approach to link physical, experimental, and clinical sciences as applied to the development of and practice in interventional electrophysiology. The Journal will examine techniques ranging from molecular, chemical and pharmacologic therapies to device and ablation technology. Accordingly, original research in clinical, epidemiologic and basic science arenas will be considered for publication. Applied engineering or physical science studies pertaining to interventional electrophysiology will be encouraged. The Journal is committed to providing comprehensive and detailed treatment of major interventional therapies and innovative techniques in a structured and clinically relevant manner. It is directed at clinical practitioners and investigators in the rapidly growing field of interventional electrophysiology. The editorial staff and board reflect this bias and include noted international experts in this area with a wealth of expertise in basic and clinical investigation. Peer review of all submissions, conflict of interest guidelines and periodic editorial board review of all Journal policies have been established.