Antiarrhythmic benefits of dual chamber stimulation with rate-response in patients with paroxysmal atrial fibrillation and chronotropic incompetence - A prospective, multicentre study

Background While the haemodynamic benefits of DDDR pacing compared with DDD pacing in patients with brady-tachy syndrome and chronotropic incompetence (CI) are well demonstrated, the antiarrhythmic advantage is controversial and so far not dearly demonstrated. Aim We have performed a prospective, randomized, multicentre study to evalu ate the efficacy of DDDR and DDD pacing modes in preventing paroxysmal atri al fibrillation (PAF) episodes in patients with brady-tachy syndrome and CI . Methods and Results Seventy-eight patients were included in the study. All patients had a dual chamber pacemaker implanted and were randomly programme d to DDD or DDDR with a cross over (DDD--> DDDR or vice versa) at 3 months. The final evaluation was performed at 6 months by means of two self-admini stered symptom questionnaires to evaluate activity. Symptoms of palpitation s were analysed and scored. The patients were less symptomatic with the DDD R mode. The number of mode-switch activations compared with symptomatic epi sodes of PAF confirmed the high rate of asymptomatic PAF episodes in patien ts with brady-tachy syndrome. We conclude that in a small but well defined population of patients affected by sick sinus syndrome with CI and severely symptomatic PAF, DDDR pacing compared with DDD pacing may offer an additio nal antiarrhythmic benefit and should be considered the primary mode of pac ing. (C) 1999 The European Society of Cardiology.