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Single vs dual chamber pacemaker
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Ongoing Large Randomized Trials of Pacemaker Selection Three large multicenter randomized trials of pacemaker selection are either in the final planning stage or already under way. The Canadian Trial Single vs dual chamber pacemaker Physiological Pacing CTOPP is a multicenter randomized trial examining the hypothesis that physiological pacing either atrial or dual-chamber reduces the risk of the combined outcome of cardiovascular death or stroke. Patients Single vs dual chamber pacemaker for an initial pacemaker implant who are not in chronic atrial fibrillation are potentially eligible for enrollment. Patients are randomized to receive either a physiological atrial or dual-chamber or a ventricular pacemaker.
Rate-adaptive pacing is required for all patients with chronotropic incompetence or complete AV block. However, the vast majority of patients randomized to physiological pacing actually receive dual-chamber devices. In addition to the primary outcome measure of cardiovascular death or stroke, the rates of occurrence of atrial fibrillation, other systemic embolism, and admission to hospital with CHF are specified secondary outcomes. Quality-of-life and economic evaluations are also being done. Thirty-five centers will contribute patients expected completion of recruitment is by February who will be followed for a minimum of 2 years. Final results are expected by late The primary outcome measure will be all-cause mortality.
It is anticipated that patients will be enrolled by 40 centers and followed for a mean of 3 years. All enrolled patients received a rate-adaptive dual-chamber pacemaker and were randomized to be initially programmed to either dual-chamber or ventricular pacing. The primary outcome measure in the pilot study is quality of life according to the Short Form Results of the pilot study are anticipated by spring of Patients with sinus node disease will receive a dual-chamber pacemaker and will have pacing mode randomized between dual-chamber and ventricular pacing.
Two thousand patients will be enrolled, and the primary outcome measure will be death or stroke.
dual chamber pacemaker
Single vs dual chamber pacemaker three trials are expected to be completed within 5 years, and the question of whether dual-chamber pacing prevents death, stroke, and heart failure compared with ventricular pacing will probably be resolved. Single vs dual chamber pacemaker Awek basah tumblr estimated that between and deaths, between 70 and 90 strokes, and between and hospitalizations for heart failure will occur in each of these studies. The patient populations of the three studies are complementary: A likely limitation of each study will be insufficient numbers of patients in specific subsets, such as those with heart failure.
However, combining data in an eventual meta-analysis should also assist in clarifying the role of dual-chamber pacing in these selected populations. The effects of different modes of pacing on quality of life, functional capacity, and cost will undoubtedly be much better understood as a result of these trials. In summary, although there are reasons to believe that dual-chamber pacing improves patient tolerance of pacing and reduces morbidity and mortality, careful analysis of existing reports reveals surprisingly few studies that are free of confounding influences. The objective of this review was to assess the short- and long-term clinical effectiveness of dual chamber pacemakers compared to single chamber ventricular pacemakers in adults with AV block, sick sinus syndrome or both.
An additional objective was to assess separately any potential differences in effectiveness between dual chamber pacing and single chamber atrial pacing. The clinical effectiveness of single chamber atrial pacing versus single chamber ventricular pacing was not examined. Citation lists and web sites were checked and researchers in the field contacted. Parallel group or crossover randomised controlled trials of at least 48 hours duration comparing dual chamber pacing and single chamber ventricular pacing, and investigating cardiovascular morbiditymortalitypatient related quality of life, exercise capacity and complication rates. Data collection and analysis: Data was extracted onto pre-piloted data extraction forms.
Quality assessment was undertaken using a checklist, with a sub-sample of quality data independently extracted by a second reviewer. Where appropriate data was available, meta-analysis was performed. Where meta-analysis was not possible, the number Single vs dual chamber pacemaker studies showing a positive, neutral or negative direction of effect and statistical significance were simply counted. Five parallel and 26 crossover randomised controlled trials were identified. The quality of reporting was found to be poor. Pooled data from parallel studies shows a statistically non-significant preference for physiologic pacing primarily dual chamber pacing for the prevention of stroke, heart failure and mortalityand a statistically significant beneficial effect regarding the prevention of atrial fibrillation odds ratio OR 0.
Both parallel and crossover studies favour dual chamber pacing with regard to pacemaker syndrome parallel: