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Hans Schüller - One of the best experts on this subject based on the ideXlab platform.
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Single Chamber Atrial Pacing: A Realistic Option in Sinus Node Disease: A Long-Term Follow-up Study of 213 Patients
Pacing and clinical electrophysiology : PACE, 2007Co-Authors: Carl J. Höijer, Hans Schüller, Peter Höglund, Johan BrandtAbstract:Background: Despite several decades of experience with atrial pacing, many centers do not apply this mode to any greater extent, mainly because of concerns for the development of future atrioventricular (AV) block or atrial fibrillation. Recent studies have emphasized possible negative effects of right ventricular stimulation, even when AV-synchrony is preserved, and have thus given rise to renewed interest in single chamber atrial pacing for Sinus Node Disease. Methods: This study presents the results of up to 19 years' follow-up of 213 patients with Sinus Node Disease treated with atrial pacing with respect to survival and causes of death, development of atrial fibrillation and AV block, and total mode survival. Patients were divided into two groups: with or without associated atrial tachyarrhythmias at the time of implant. Results are given for all patients and for the two groups separately. Results: The mean follow-up time was 10.1 years. The survival of the entire group was lower after 10 years than that of an age and gender-matched general Swedish population. This was caused by patients with the brady-tachy syndrome (BT) having a significantly higher mortality rate than controls, whereas those with bradycardia only (B) had survival comparable to the general population. Permanent atrial fibrillation (AF) developed in 20% of patients and was significantly more common in patients with BT. The majority of patients with AF (78%) no longer needed any pacing, i.e., did not require ventricular stimulation due to slow ventricular rate. The annual incidence of high grade AV block was 1.8%. If patients with preexisting bundle branch block were excluded, the incidence was 1.6%. No fatal episode of AV block was seen. The overall mode survival at the end of follow-up was 75%, with 155 patients still with atrial pacemakers. Conclusion: Atrial pacing is a safe and reliable mode of pacing in patients with Sinus Node Disease, even in the very long-term. (Less)
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Pacing for Sinus Node Disease : a therapeutic rationale
Clinical cardiology, 1994Co-Authors: Johan Brandt, Hans SchüllerAbstract:Symptomatic Sinus Node Disease is a common indication for permanent pacemaker implantation. Single-chamber ventricular (VVI) pacing, single-chamber atrial (AAI) stimulation, and dual-chamber (DDD or DDI) systems are used to a varying extent at different implanting centers. Hemodynamic and clinical studies relevant to the choice of pacing mode in these patients are reviewed. The data currently available strongly support the use of pacing systems providing atrial stimulation. The choice between single-chamber atrial or dual-chamber pacing can be based on the relative importance assigned to a number of factors: Hemodynamic aspects, the risk of ventricular lead problems, cost, and complexity aspects favor AAI pacing, whereas patients with a substantial risk of developing atrioventricular block should receive a DDD or DDI unit.
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Natural history of Sinus Node Disease treated with atrial pacing in 213 patients: Implications for selection of stimulation mode
Journal of the American College of Cardiology, 1992Co-Authors: Johan Brandt, Harald Anderson, Thomas Fåhraeus, Hans SchüllerAbstract:Objectives. This study was designed to analyze the incidence and determinants of complications and long-term survival in Sinus Node Disease treated with atrial pacing. Background. Knowledge of the natural history of Sinus Node Disease treated with different pacing modes is imperfect, and controversy exists regarding the optimal pacemaker therapy. Methods. A consecutive series of 213 patients with Sinus Node Disease initially treated with atrial pacing was studied for a median follow-up period of 60 months. The end points studied were permanent atrial fibrillation, high grade atrioventricular (AV) block, P wave undersensing, pacing mode change, reoperation and death. Several prognostic factors were evaluated statistically and the survival rate was compared with that of a matched general population. Results. The incidence rate of permanent atrial fibrillation during follow-up was 7% (1.4%/year). The risk of this arrhythmia increased substantially with age ≥ 70 years at pacemaker implantation. Only 2 of the 15 patients who developed permanent atrial fibrillation required ventricular pacing. High grade AV block occurred in 8.5% (1.8%/year) and its incidence was much greater in patients with complete bundle branch block or bifascicular block (35%) than in patients without such conduction disturbances (6%). A change to ventricular or dual-chamber stimulation was necessary in 14% of all patients, primarily because of early lead dislodgment or high grade AV block. Surgical intervention with maintenance of atrial pacing was required in 7% of patients. The survival rates of 97% at 1 year, 89% at 5 years and 72% at 10 years did not differ significantly from those of a matched general population. Conclusions. In Sinus Node Disease, atrial pacing can be successfully applied during long-term follow-up. Patients with complete bundle branch or bifascicular block in addition to Sinus Node Disease should initially receive a dual-chamber pacemaker, but routine application of dual-chamber stimulation does not appear to be warranted.
Gervasio A Lamas - One of the best experts on this subject based on the ideXlab platform.
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Reduced ejection fraction, sudden cardiac death, and heart failure death in the mode selection trial (MOST): implications for device selection in elderly patients with Sinus Node Disease.
Journal of cardiovascular electrophysiology, 2008Co-Authors: Michael O Sweeney, Anne S Hellkamp, Kenneth A Ellenbogen, Gervasio A LamasAbstract:Background: The purpose of this study was to describe the incidence and predictors of sudden cardiac death (SCD) and heart failure (HF) death, and coexisting indications for ICDs and CRT, in patients with Sinus Node Disease (SND) treated with pacemakers. Methods and Results: Baseline variables were used to predict SCD and HF death among 1,135 patients in the Mode Selection Trial, a 6-year trial of pacing mode in SND. There were 73 deaths among 177 patients with EF ≤ 35% (41.2%), 46/156 (29.5%) with EF 36–49%, and 147/802(18.3%) with EF ≥ 50%. SCD accounted for 21.9%, 23.9%, and 14.3% of deaths with EF ≤ 35%, 36–49%, and ≥ 50%. HF deaths accounted for 23.3%, 19.6%, and 3.4% of deaths with EF ≤ 35%, 36-49%, and ≥ 50%. EF ≤ 35% predicted SCD (hazard ratio [HR] 3.68, 95% confidence interval [CI] 1.72-7.89, P = 0.002) and HF death (HR 10.17, 95% CI 3.35, 30.82, P = 0.001). Four-year SCD rate with EF ≤ 35% was 15.5% (3.9% annually). Nearly one-fifth of patients qualified for ICDs (EF ≤ 35%) and half of these had QRS ≥ 120 ms. However, >40% died within 33 months (4-year noncardiac death rate ∼22%). Conclusions: Reduced EF predicts SCD and HF death in SND treated with pacemakers. SCD rates among patients with EF ≤ 35% are similar to control arms of primary prevention ICD trials, but mortality rates are significantly higher. Whether ICDs or CRT to provide bradycardia support would prolong life in elderly patients with EF ≤ 35% and SND merits prospective investigation.
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minimizing ventricular pacing to reduce atrial fibrillation in Sinus Node Disease
The New England Journal of Medicine, 2007Co-Authors: Michael O Sweeney, Alan J Bank, Emmanuel Nsah, Maria Koullick, Qian Cathy Zeng, Douglas A Hettrick, Todd J Sheldon, Gervasio A LamasAbstract:Methods We randomly assigned 1065 patients with Sinus-Node Disease, intact atrioventricular conduction, and a normal QRS interval to receive conventional dual-chamber pacing (535 patients) or dual-chamber minimal ventricular pacing with the use of new pacemaker features designed to promote atrioventricular conduction, preserve ventricular conduction, and prevent ventricular desynchronization (530 patients). The primary end point was time to persistent atrial fibrillation. Results The mean (±SD) follow-up period was 1.7±1.0 years when the trial was stopped because it had met the primary end point. The median percentage of ventricular beats that were paced was lower in dual-chamber minimal ventricular pacing than in conventional dual-chamber pacing (9.1% vs. 99.0%, P<0.001), whereas the percentage of atrial beats that were paced was similar in the two groups (71.4% vs. 70.4%, P = 0.96). Persistent atrial fibrillation developed in 110 patients, 68 (12.7%) in the group assigned to conventional dual-chamber pacing and 42 (7.9%) in the group assigned to dual-chamber minimal ventricular pacing. The hazard ratio for development of persistent atrial fibrillation in patients with dual-chamber minimal ventricular pacing as compared with those with conventional dual-chamber pacing was 0.60 (95% confidence interval, 0.41 to 0.88; P = 0.009), indicating a 40% reduction in relative risk. The absolute reduction in risk was 4.8%. The mortality rate was similar in the two groups (4.9% in the group receiving dual-chamber minimal ventricular pacing vs. 5.4% in the group receiving conventional dual-chamber pacing, P = 0.54). Conclusions Dual-chamber minimal ventricular pacing, as compared with conventional dualchamber pacing, prevents ventricular desynchronization and moderately reduces the risk of persistent atrial fibrillation in patients with Sinus-Node Disease. (ClinicalTrials. gov number, NCT00284830.)
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Minimizing Ventricular Pacing to Reduce Atrial Fibrillation in Sinus-Node Disease
The New England journal of medicine, 2007Co-Authors: Michael O Sweeney, Alan J Bank, Emmanuel Nsah, Maria Koullick, Qian Cathy Zeng, Douglas A Hettrick, Todd J Sheldon, Gervasio A LamasAbstract:Methods We randomly assigned 1065 patients with Sinus-Node Disease, intact atrioventricular conduction, and a normal QRS interval to receive conventional dual-chamber pacing (535 patients) or dual-chamber minimal ventricular pacing with the use of new pacemaker features designed to promote atrioventricular conduction, preserve ventricular conduction, and prevent ventricular desynchronization (530 patients). The primary end point was time to persistent atrial fibrillation. Results The mean (±SD) follow-up period was 1.7±1.0 years when the trial was stopped because it had met the primary end point. The median percentage of ventricular beats that were paced was lower in dual-chamber minimal ventricular pacing than in conventional dual-chamber pacing (9.1% vs. 99.0%, P
Laurent Fauchier - One of the best experts on this subject based on the ideXlab platform.
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Ischemic Stroke in Patients With Sinus Node Disease, Atrial Fibrillation, and Other Cardiac Conditions
Stroke, 2020Co-Authors: Alexandre Bodin, Arnaud Bisson, Christophe Gaborit, J Herbert, Nicolas Clementy, Dominique Babuty, Gregory Y.h. Lip, Laurent FauchierAbstract:Background and Purpose— Atrial fibrillation (AF) is known to increase risk of ischemic stroke (IS), but the risk of IS in isolated Sinus Node Disease (SND) is unclear. We compared the incidence of ...
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P5675Ischemic stroke in patient with Sinus Node Disease in comparison to atrial fibrillation, bradycardia-tachycardia syndrome and other cardiac conditions: a nationwide cohort-study
European Heart Journal, 2019Co-Authors: Alexandre Bodin, Arnaud Bisson, Christophe Gaborit, J Herbert, Nicolas Clementy, Dominique Babuty, Bertrand Pierre, L Guillon Grammatico, Laurent FauchierAbstract:Abstract Atrial fibrillation (AF) may be associated with Sinus Node Disease (SND) presenting as a brady-tachy syndrome (BTS), known to be at risk for embolic ischemic stroke (IS). It remains unclear whether the risk of IS is increased in patients with isolated SND. Methods This French longitudinal cohort study was based on the national database covering hospital care from for the entire population (PMSI) from 2010 to 2015. We compared incidences of IS in patients with a diagnosis of AF or SND to that in a control group of patients with a main diagnosis of cardiac condition (excluding those with AF or SND, history of stroke and mechanical valve or mitral stenosis). Results Of 1,732,412 patients included in the cohort, 1,601,435 (92.44%) had isolated AF, 102,849 (5.94%) had isolated SND and 28,128 (1.62%) had BTS. The control group with cardiac condition included 479,108 patients. Incidence of IS progressively increased when considering patients from the control population, patients with isolated SND, with BTS or with isolated AF (0.67%/yr, 1.95%/yr, 3.03%/yr and 5.48%/yr respectively). These differences were seen in all strata of CHA2DS2VASc score (table). SND patients with a CHA2DS2-VASc score ≥3 had a yearly incidence of IS >2%, comparable to AF population with a CHA2DS2-VASc score ≥1. Incidence (%/year) of ischemic stroke CHA2DS2-VASc AF population SND population “Control” population Women Men Women Men Women Men All scores 6.72% 4.37% 1.93% 1.96% 0.67% 0.68% Score = 0 – 1.960% – 1.211% – 0.217% Score = 1 2.337% 3.046% 0.538% 1.486% 0.166% 0.345% Score = 2 3.917% 4.499% 0.879% 1.541% 0.298% 0.580% Score = 3 7.572% 4.733% 2.207% 2.084% 0.541% 0.907% Score = 4 7.016% 4.820% 2.363% 2.305% 0.930% 1.278% Score = 5 6.725% 5.345% 2.845% 2.849% 1.249% 1.553% Score = 6 7.637% 7.543% 3.319% 4.109% 1.737% 2.031% Score = 7 10.196% 13.927% 4.663% 7.708% 2.346% 4.089% Score = 8 17.654% 12.607% 8.519% 11.904% 2.446% 2.355% Conclusion Patients with isolated SND had a lower risk of IS than patients with AF or BTS. However, SND patients had a non-neglectable risk of IS during follow-up which was higher than in a “control” population. Whether oral anticoagulation may bring a significant clinical benefit might be studied in patients with SND at highest risk of IS.
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Comparison of stroke risk according to Sinus Node Disease, atrial fibrillation and bradycardia-tachycardia syndrome: A French nationwide cohort-study
Archives of Cardiovascular Diseases Supplements, 2019Co-Authors: Alexandre Bodin, Arnaud Bisson, Christophe Gaborit, Nicolas Clementy, Dominique Babuty, C Andre, Bertrand Pierre, F Mondout, Laurent FauchierAbstract:Background Atrial fibrillation (AF) may commonly be associated with Sinus Node Disease (SND) presenting as the so-called bray-tachy syndrome (BTS). BTS and AF are known to be at risk for ischemic stroke (IS). It remains unclear whether the risk of IS is similar in patients with isolated SND. Purpose Our objective was to compare the risk of IS in AF, SND and BTS patients and to identify risk factors of stroke in patients with SND. Methods This French longitudinal cohort study was based on the national hospitalization database, the Programme de medicalisation des systemes d’information (PMSI). We included all patients over 18 y.o. in France from January 2010 to December 2015 hospitalized with a main or related diagnosis of AF or SND. Baseline characteristics were pooled into a multivariate Cox model to identify significant predictors of IS. Results Of 1,732,412 patients included after exclusion of pacemaker or implantable cardiac defibrillator patients (PM/ICD), 1,601,435 (92.44%) had AF, 102,849 (5.94%) SND and 28,128 (1.62%) BTS. Compared to patients with AF or BTS, those with SND were younger, had a lower CHA2DS2-VASc score. Incidence of IS during follow-up was higher in AF than in BTS patients (yearly rate 4.90% vs. 2.73%, P Conclusion Patients with SND have a lower risk of thromboembolic events than those with AF or BTS. However, SND patients with a CHA2DS2-VASc score ≥ 2 had a markedly higher risk of IS during follow-up and may need specific considerations.
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Impact of Sinus Node Disease on atrial fibrillation prognosis: A community based cohort study
Archives of Cardiovascular Diseases Supplements, 2018Co-Authors: Arnaud Bisson, Alexandre Bodin, Nicolas Clementy, Dominique Babuty, C Andre, Bertrand Pierre, Laurent FauchierAbstract:Background Atrial fibrillation (AF) may commonly be associated with Sinus Node Disease (SND) presenting as the so-called brady-tachy syndrome. Such patients are known to be at risk for embolic stroke. It remains unclear whether the risk of stroke is higher in this setting, and if antithrombotic management should be different, particularly in patients with a low CHA2DS2-VASc score. Purpose We aimed to describe and compare the risk of stroke in AF patients with and with no SND. Methods All patients with AF seen in our institution between 2000 and 2010 were identified in a database. Outcomes were investigated during follow-up. Results Among 8962 patients with AF, 548 (6%) had SND among whom 237 (43%) where treated with a pacemaker. Patients with SND were older than patients with no SND (73.8 ± 11.9 versus 70.6 ± 14.7, P Conclusion AF patients with SND had a similar risk of stroke/TE than other AF patients. SND was not an independent risk factor for stroke when using a contemporary risk stratification scheme with the CHA2DS2-VASc score. Use of OAC was overall associated with a better prognosis in these patients.
Johan Brandt - One of the best experts on this subject based on the ideXlab platform.
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Single Chamber Atrial Pacing: A Realistic Option in Sinus Node Disease: A Long-Term Follow-up Study of 213 Patients
Pacing and clinical electrophysiology : PACE, 2007Co-Authors: Carl J. Höijer, Hans Schüller, Peter Höglund, Johan BrandtAbstract:Background: Despite several decades of experience with atrial pacing, many centers do not apply this mode to any greater extent, mainly because of concerns for the development of future atrioventricular (AV) block or atrial fibrillation. Recent studies have emphasized possible negative effects of right ventricular stimulation, even when AV-synchrony is preserved, and have thus given rise to renewed interest in single chamber atrial pacing for Sinus Node Disease. Methods: This study presents the results of up to 19 years' follow-up of 213 patients with Sinus Node Disease treated with atrial pacing with respect to survival and causes of death, development of atrial fibrillation and AV block, and total mode survival. Patients were divided into two groups: with or without associated atrial tachyarrhythmias at the time of implant. Results are given for all patients and for the two groups separately. Results: The mean follow-up time was 10.1 years. The survival of the entire group was lower after 10 years than that of an age and gender-matched general Swedish population. This was caused by patients with the brady-tachy syndrome (BT) having a significantly higher mortality rate than controls, whereas those with bradycardia only (B) had survival comparable to the general population. Permanent atrial fibrillation (AF) developed in 20% of patients and was significantly more common in patients with BT. The majority of patients with AF (78%) no longer needed any pacing, i.e., did not require ventricular stimulation due to slow ventricular rate. The annual incidence of high grade AV block was 1.8%. If patients with preexisting bundle branch block were excluded, the incidence was 1.6%. No fatal episode of AV block was seen. The overall mode survival at the end of follow-up was 75%, with 155 patients still with atrial pacemakers. Conclusion: Atrial pacing is a safe and reliable mode of pacing in patients with Sinus Node Disease, even in the very long-term. (Less)
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Pacing for Sinus Node Disease : a therapeutic rationale
Clinical cardiology, 1994Co-Authors: Johan Brandt, Hans SchüllerAbstract:Symptomatic Sinus Node Disease is a common indication for permanent pacemaker implantation. Single-chamber ventricular (VVI) pacing, single-chamber atrial (AAI) stimulation, and dual-chamber (DDD or DDI) systems are used to a varying extent at different implanting centers. Hemodynamic and clinical studies relevant to the choice of pacing mode in these patients are reviewed. The data currently available strongly support the use of pacing systems providing atrial stimulation. The choice between single-chamber atrial or dual-chamber pacing can be based on the relative importance assigned to a number of factors: Hemodynamic aspects, the risk of ventricular lead problems, cost, and complexity aspects favor AAI pacing, whereas patients with a substantial risk of developing atrioventricular block should receive a DDD or DDI unit.
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Natural history of Sinus Node Disease treated with atrial pacing in 213 patients: Implications for selection of stimulation mode
Journal of the American College of Cardiology, 1992Co-Authors: Johan Brandt, Harald Anderson, Thomas Fåhraeus, Hans SchüllerAbstract:Objectives. This study was designed to analyze the incidence and determinants of complications and long-term survival in Sinus Node Disease treated with atrial pacing. Background. Knowledge of the natural history of Sinus Node Disease treated with different pacing modes is imperfect, and controversy exists regarding the optimal pacemaker therapy. Methods. A consecutive series of 213 patients with Sinus Node Disease initially treated with atrial pacing was studied for a median follow-up period of 60 months. The end points studied were permanent atrial fibrillation, high grade atrioventricular (AV) block, P wave undersensing, pacing mode change, reoperation and death. Several prognostic factors were evaluated statistically and the survival rate was compared with that of a matched general population. Results. The incidence rate of permanent atrial fibrillation during follow-up was 7% (1.4%/year). The risk of this arrhythmia increased substantially with age ≥ 70 years at pacemaker implantation. Only 2 of the 15 patients who developed permanent atrial fibrillation required ventricular pacing. High grade AV block occurred in 8.5% (1.8%/year) and its incidence was much greater in patients with complete bundle branch block or bifascicular block (35%) than in patients without such conduction disturbances (6%). A change to ventricular or dual-chamber stimulation was necessary in 14% of all patients, primarily because of early lead dislodgment or high grade AV block. Surgical intervention with maintenance of atrial pacing was required in 7% of patients. The survival rates of 97% at 1 year, 89% at 5 years and 72% at 10 years did not differ significantly from those of a matched general population. Conclusions. In Sinus Node Disease, atrial pacing can be successfully applied during long-term follow-up. Patients with complete bundle branch or bifascicular block in addition to Sinus Node Disease should initially receive a dual-chamber pacemaker, but routine application of dual-chamber stimulation does not appear to be warranted.
Peter J Mohler - One of the best experts on this subject based on the ideXlab platform.
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TRPM4 modulates Sinus Node diastolic depolarization
Heart rhythm, 2013Co-Authors: Sean C. Little, Peter J MohlerAbstract:The sinoatrial Node (SAN) is the intrinsic pacemaker of the vertebrate heart, which is responsible for the generation and modulation of cardiac automaticity. Dysfunction of pacemaking function is associated with a host of human arrhythmia phenotypes termed Sinus Node Disease or “sick Sinus syndrome.” Sinus Node Disease may include phenotypes of Sinus bradycardia, Sinus Node exit block, Sinus Node pause/arrest, and instances of atrial brady/tachyarrhythmias. 1 Sinus Node Disease affects hundreds of thousands of individuals in the United States annually and results in tens of thousands of patients requiring pacemaker therapy each year. While SAN-linked arrhythmias may occur in children with congenital forms of sick Sinus syndrome, phenotypes can occur at any age, although the prevalence increases with age. In fact, 1 of every 600 patients with cardiac Disease who are older than 65 years requires pacemaker implantation. 2 Previous work has suggested that the age-dependent decline of SAN function, symptoms that include a decrease in intrinsic heart rate and increase in action potential duration (APD), could be attributed to fibrosis. 3,4 However, more recent evidence links dysfunction in ion channel and transporter regulation in the pathogenesis of SAN Disease. Over the last 2 decades, our understanding of SAN ion channel/transporter expression and modulation has dramatically increased. The ability of the SAN to generate spontaneous electrical activity is dependent on the synchronized activation of SAN ion channels and transporters. SAN diastolic depolarization is generated by the hyperpolarization-activated cyclic nucleotide-gated (HCN4) channel and the Na/Ca exchanger (NCX). Once the SAN cell membrane potential reaches the threshold potential of both L- and T-type calcium channels, the action potential (AP) is modulated by a host of additional membrane and sarcoplasmic reticulum (SR) Ca 2þ regulatory
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Defects in cytoskeletal signaling pathways, arrhythmia, and sudden cardiac death
Frontiers in Physiology, 2012Co-Authors: Sakima A Smith, Jerry Curran, Thomas J Hund, Peter J MohlerAbstract:Ankyrin polypeptides are cellular adapter proteins that tether integral membrane proteins to the cytoskeleton in a host of human organs. Initially identified as integral components of the cytoskeleton in erythrocytes, a recent explosion in ankyrin research has demonstrated that these proteins play prominent roles in cytoskeletal signaling pathways and membrane protein trafficking/regulation in a variety of excitable and non-excitable cells including heart and brain. Importantly, ankyrin research has translated from bench to bedside with the discovery of human gene variants associated with ventricular arrhythmias that alter ankyrin–based pathways. Ankyrin polypeptides have also been found to play an instrumental role in various forms of Sinus Node Disease and atrial fibrillation. Mouse models of ankyrin deficiency have played fundamental roles in the translation of ankyrin-based research to new clinical understanding of human Sinus Node Disease, atrial fibrillation, and ventricular tachycardia.