https://doi.org/10.55788/67efca94
“Sinus node disease and AF often coexist,” stated Dr Mads Brix Kronborg (Aarhus University, Denmark) [1]. “In patients with sinus node disease, a higher percentage of atrial pacing has been linked to an increased risk of AF. Whether this increased risk is caused by abnormal prolongation and propagation of atrial depolarisation induced by pacing or whether it may result from an increased need for pacing in more progressive atrial disease is not known.”
The current DANPACE II trial was designed to determine whether minimising atrial pacing reduces the risk of AF in patients with sinus node dysfunction. Participants (n=539) with sinus node dysfunction undergoing first-time pacemaker implantation were randomised 1:1 to pacing programmed to a base rate of 60 bpm with rate-adaptive pacing (DDDR-60) or pacing programmed to a base rate of 40 bpm without rate-adaptive pacing (DDD-40). The included patients were remotely monitored for 2 years. The primary endpoint was the first device-detected episode of AF lasting over 6 minutes.
The median percentage of atrial pacing was 1% in the DDD-40 arm and 49% in the DDDR-60 arm. However, this reduced atrial pacing did not result in a decreased incidence of AF >6 minutes (46% in both arms; log-rank P=0.83). Furthermore, AF >6 hours was observed in 36% of the participants in the DDD-40 group and 32% of those in the DDDR-60 group (log-rank P=0.35). The corresponding results for AF > 24 hours were 26% for the DDD-40 arm and 21% for the DDDR-60 arm. Syncope or pre-syncope occurred more frequently in the DDD-40 arm (22% vs 13%; log-rank P=0.01). Also, the rate of crossovers was higher in the DDD-40 arm at 23%, compared with 3% in the DDDR-60 arm (log-rank P<0.001).
In conclusion, a reduction in atrial pacing did not lead to a reduction in the incidence of AF in patients with sinus node dysfunction who received a first pacemaker but resulted in a higher rate of syncope.
- Kronborg MB, et al. DANPACE II: minimized atrial pacing and risk of atrial fibrillation in sinus node dysfunction. Hot Line Session 7, ESC Congress 2023, 25–28 August, Amsterdam, the Netherlands.
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Table of Contents: ESC 2023
Featured articles
How to manage arterial thrombosis and thromboembolism in COVID-19?
2023 ESC Guidelines & Updates
Heart failure: the 2023 update
Guidelines for Acute Coronary Syndrome
Guidelines for the management of cardiomyopathies
Cardiovascular disease and diabetes: new guidelines
Guidelines for the management of endocarditis
Trial Updates in Heart Failure
Traditional Chinese medicine successful in HFrEF
CRT upgrade benefits patients with HFrEF and an ICD
Catheter ablation saves lives in end-stage HF with AF
Meta-analysis: Does FCM improve clinical outcomes in HF?
HEART-FID: Is intravenous ferric carboxymaltose helpful in HFrEF with iron deficiency?
Natriuresis-guided diuretic therapy to facilitate decongestion in acute HF
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Key Research on Prevention
Does colchicine prevent perioperative AF and MINS?
Diagnostic tool doubles cardiovascular diagnoses in patients with COPD or diabetes
Inorganic nitrate strongly reduces CIN in high-risk patients undergoing angiography
Finetuning Antiplatelet and Anticoagulation Therapy
Should we use anticoagulation in AHRE to prevent stroke?
Results of FRAIL-AF trial suggest increased bleeding risk with DOACs
The optimal duration of anticoagulation therapy in cancer patients with DVT
DAPT or clopidogrel monotherapy after stenting in high-risk East-Asian patients?
Assets for ACS and PCI Optimisation
Immediate or staged revascularisation in STEMI plus multivessel disease?
Lp(a) and cardiovascular events: which test is the best?
No benefit of extracorporeal life support in MI plus cardiogenic shock
Functional revascularisation outperforms culprit-only strategy in older MI patients
Can aspirin be omitted after PCI in patients with high bleeding risk?
Angiography vs OCT vs IVUS guidance for PCI: a network meta-analysis
OCTOBER trial: OCT-guided PCI improves clinical outcomes in bifurcation lesions
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Minimising atrial pacing does not reduce the risk for AF in sinus node disease
ARAMIS: Can anakinra alleviate acute myocarditis?
Expedited transfer to a specialised centre does not improve cardiac arrest outcomes
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