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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EDual-chamber pacing improved long-term outcomes compared with single-chamber pacing in patients with sick sinus syndrome in the long-term Danish Multicenter Randomized Study on AAIR Versus DDDR Pacing in Sick Sinus Syndrome [DANPACE; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00236158\u0026amp;atom=%2Fspmdc%2F10%2F8%2F15.2.atom\u0022\u003ENCT00236158\u003C\/a\u003E] study and should be the preferred pacing mode in these patients.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EArrhythmias\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EDual-chamber pacing improved long-term outcomes compared with single-chamber pacing in patients with sick sinus syndrome (SSS) in the long-term Danish Multicenter Randomized Study on AAIR Versus DDDR Pacing in Sick Sinus Syndrome (DANPACE; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00236158\u0026amp;atom=%2Fspmdc%2F10%2F8%2F15.2.atom\u0022\u003ENCT00236158\u003C\/a\u003E) study and should be the preferred pacing mode in these patients, according to investigators from the DANPACE study.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EBradycardia can be treated with several types of pacing, including rate-adaptive single-lead atrial pacing (AAIR), rate-adaptive ventricular (VVIR) pacing, and rate-adaptive dual-chamber pacing (DDDR). However, after VVIR pacing was shown to increase the risk of atrial fibrillation (AF) compared with physiological pacing in patients with SSS [Andersen HR, Nielsen JC, Thomsen PE et al. \u003Cem\u003ELancet.\u003C\/em\u003E 1997], AAIR and DDDR became the standard options for controlling bradycardia in SSS, said Jens Cosedis Nielsen, MD, PhD, Aarhus University Hospital, Skejby, Denmark. The Danish trial is the first large, multicenter, randomized trial that is designed to compare long-term outcomes that are associated with AAIR and DDDR pacing in patients with SSS.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EIn DANPACE, 1415 patients with SSS were randomly assigned to receive AAIR devices (n=707) or DDDR devices (n=708). The primary endpoint was all-cause mortality. Secondary endpoints included AF, stroke, heart failure hospitalization, and pacemaker reoperation.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EAfter a mean follow-up of 5.4 years, the all-cause mortality rates were similar in the AAIR and DDDR groups (p=0.53). Patients in the AAIR and DDDR groups also had similar rates of stroke (p=0.56), diuretic use (p=0.89), and heart failure hospitalization (p=0.90).\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EPatients in the DDDR group had a lower rate of paroxysmal AF than those in the AAIR group (p=0.024) and were less likely to require pacemaker reoperation (p\u0026lt;0.001). As illustrated by Kaplan-Meier survival curves, these benefits, favoring dual-chamber pacing, were apparent within 12 months of randomization.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EIn a multivariate analysis, AAIR was associated with a 24% higher rate of paroxysmal AF (HR, 1.24; 95% CI, 1.01 to 1.52; p=0.042) and a 2-fold increase in the risk of pacemaker reoperation (HR, 2.00; 95% CI, 1.54 to 2.61; p\u0026lt;0.001) compared with DDDR.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EA similar percentage of atrial beats were paced in the AAIR and DDDR groups (58% vs 59%; p=0.52). In the DDDR group, 65% of the ventricular beats were paced. DDDR pacing with an AV interval \u2264220 milliseconds was the preferred pacing mode for patients with SSS.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EDANPACE investigators concluded that AAIR pacing should no longer be used in patients with SSS, but other experts disagreed. DANPACE discussant Carina Blomstr\u00f6m-Lundqvist, MD, Uppsala University, Uppsala, Sweden, said that AAIR pacing may have an important role in some patients with SSS, such as those with sinus dysfunction and no suspected abnormality of AV conduction. Additional studies with long-term efficacy and safety outcomes may help to determine the optimal pacing mode for different subgroups of patients with SSS.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2010 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/10\/8\/15.2.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmp1p\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}