Arrhythmias & electrophysiologyRandomised controlled trial
Closed loop stimulation reduces the incidence of atrial high-rate episodes compared with conventional rate-adaptive pacing in patients with sinus node dysfunctions
- Randomised controlled trial
All atrial high-rate episodes (AHREs) independently adjudicated using intra-cardiac electrograms
Authors' conclusion
Dual-chamber CLS in patients with SND is associated with a significantly lower AHRE incidence than conventional DDDR pacing.
Study context
- Population
- Patients with sinus node dysfunction and an implanted pacemaker or defibrillator requiring DDDR pacing
- Participants
- 612 vs 598
- Comparison
- Closed loop stimulation vs conventional accelerometer-based DDDR pacing
- Closed loop stimulation (CLS)n = 612
- DDDRn = 598reference
- Primary endpoint
- Time to first AHRE lasting ≥6 min, stroke or TIA
- Follow-up
- 3 years
Primary result
As reported in the abstract
CLS vs DDDRHazard ratio (95% CI)P value
unadjusted, site-stratified
0.84(0.72–0.99)
P = 0.035adjusted for CHA2DS2-VASc score
0.84(0.71–0.99)
P = 0.033Further findings
| Outcome | HR | P value |
|---|---|---|
| AHRE incidence, no atrioventricular block (subgroup) | 0.77 | P = 0.008 |
| AHRE incidence, no AF history (subgroup) | 0.73 | P = 0.009 |
Stroke/transient ischaemic attack (TIA) contribution to primary endpoint
- Low and not statistically different between arms
- 1.3%
Original publication
Closed loop stimulation reduces the incidence of atrial high-rate episodes compared with conventional rate-adaptive pacing in patients with sinus node dysfunctions. Europace. Published 28 June 2024. doi:10.1093/europace/euae175
Summarised from the published abstract; every number is checked against it