Is Dual Defibrillator Better than Conventional DDD Pacing in Brady-Tachy Syndrome? Results of the ICARUS Trial (Internal Cardioversion Antitachypacing and Prevention: Resource Utilization Study)
- 57 Downloads
Aim of the study: To compare the impact of dual defibrillator versus conventional DDD pacing on quality of life and hospitalizations in patients with sinus node disease and recurrent symptomatic atrial fibrillation.
Study design: Prospective, parallel, controlled trial.
Methods: Sixty-three patients (41 M, mean age 71 ± 8 years) with sinus node disease and at least three symptomatic episodes of atrial fibrillation during the last year were enrolled. Thirty-one consecutive patients received a dual defibrillator (group A) and 32 standard DDD pacing (group B). In group A, 12 patients received an external remote-control device in order to shock themselves in case of atrial fibrillation, while 19 were scheduled for early in-hospital manual shock. Seventy-five percent had been hospitalized during the last year and 57% had required electrical cardioversion. Atrial fibrillation was persistent in 63.5% and paroxysmal in 37.5%. The follow-up lasted 1 year.
Results: Atrial fibrillation recurred in 83.3% in group A and 79.3% in group B (p = ns). Electrical cardioversion was applied in 54.8% in group A and in 21.9% in group B (p < 0.05). On the whole, 89.5% of electrical cardioversions were delivered in the defibrillator group (p < 0.0001). In the whole population 27.0% patients had cardiac-related hospitalization (31.2% in the pacemaker group and 22.6% in the defibrillator group, p = n.s.). In patients with persistent atrial fibrillation, cardiac-related hospitalization rate was significantly lower in the group A (0% vs. 30%, p < 0.05). Considering Symptom Check List, symptoms significantly improved in the whole population, but symptom number and frequency improved significantly only in the group A. Similarly, SF-36 questionnaire scores showed a little higher quality of life improvement in the group A.
Conclusions: Dual defibrillator showed consistent trends toward a higher effectiveness when compared with standard DDD pacing. Dual defibrillator was associated to reduced in-patient cardioversions and to better quality of life. All-cause hospitalizations were reduced only in patients with persistent atrial fibrillation
Keywordsbrady-tachy syndrome atrial fibrillation dual chamber pacing dual defibrillator
Unable to display preview. Download preview PDF.
- 13.Lamas GA, Lee KL, Sweeney MO, Silverman R, Leon A, Yee R, Marinchak RA, Flaker G, Schron E, Orav EJ, Hellkamp AS, Goldman L, for the Mode Selection Trial in Sinus Node Dysfunction. Ventricular pacing or dual chamber pacing for sinus node dysfunction. N Engl J Med 2002;346:1854–1862.CrossRefPubMedGoogle Scholar
- 14.Ricci R, Santini M, Puglisi A, Azzolini P, Capucci A, Pignalberi C, Boriani G, Botto GL, Spampinato A, Bellocci F, Proclemer A, Grammatico A, de Seta F. Impact of consistent atrial pacing algorithm on premature atrial complexe number and paroxysmal atrial fibrillation recurrences in brady-tachy syndrome: A randomized prospective cross over study. J Interv Card Electrophysiol 2001;5:33–44.CrossRefPubMedGoogle Scholar
- 16.Ricci R, Pignalberi C, Disertori M, Capucci A, Padeletti L, Botto G, Boriani G, Miraglia F, de Santo T, Santini M. Antitachycardia pacing therapy to treat spontaneous atrial tachyarrhythmias: The 7250 Dual Defibrillator Italian Registry. Eur Heart J 2001;3(Suppl. P):P25–P32.Google Scholar
- 19.Ricci R, Pignalberi C, Disertori M, Capucci A, Padeletti L, Botto G, Toscano S, Miraglia F, Grammatico A, Santini M. Efficacy of a dual chamber defibrillator with atrial antitachycardia functions in treating spontaneous atrial tachyarrhythmias in patients with life-threatening ventricular tachyarrhythmias. Eur Heart J 2002;23:1471–1479.CrossRefPubMedGoogle Scholar
- 20.Adler SW, Wolpert C, Warman EN, Musley SK, Koehler JL, Euler DE for the Worldwide Jewel AF Investigators. Efficacy of pacing therapies for treating atrial tachyarrhythmias in patients with ventricular arrhythmias receiving a dual-chamber implantable cardioverter defibrillator. Circulation 2001;104:887–892.PubMedGoogle Scholar
- 22.Savelieva I, Camm J. The results of pacing trials for the prevention and termination of atrial tachyarrhythmias: Is there any evidence of therapeutic breakthrough? J Interv Cardiac Electrophysiol 2003;8:103–115.Google Scholar
- 24.Ware JE. The SF-36 health survey manual and interpretation guide. Boston, MA, The Health Institute, New England Medical Center; 1993.Google Scholar
- 26.McHorney CA, Ware JE, Raczek AE. The MOS 36-item short-form health (SF-36). II. Psychometric and clinical tests of validity in measuring physical and mental health conditions. Med. Care 1993;81:247–263.Google Scholar
- 27.McHorney CA, Ware JE, Lu JFR, Sherbourne CD. The MOS 36-item short-form health (SF-36), III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med. Care 1994;82:40–66.Google Scholar
- 28.Bubien RS, Kay GN, Jenkins LS. Test specifications for symptom checklist. Frequency and severity. 1993. Milwaukee, University of Wisconsin-Milwaukee.Google Scholar
- 31.De Sisti A, Leclercq JF, Fiorello P, Manot S, Halimi F, Attuel P. Electrophysiologic characteristics of the atrium in sinus node dysfunction: Atrial refractoriness and conduction. J Cardiovasc Electrophysiol 2000;11:30–33.Google Scholar
- 32.De Sisti A, Attuel P, Manot S, Fiorello P, Halimi F, Leclercq JF. Electrophysiological determinants of atrial fibrillation in sinus node dysfunction despite atrial pacing. Europace 2000;2:304–311.Google Scholar
- 40.Padeletti L, Pieragnoli P, Ciapetti C, Colella A, Musilli N, Porciani MC, Ricci R, Pignalberi C, Santini M, Puglisi A, Azzolini P, Spampinato A, Martelli M, Capucci A, Boriani G, Botto G, Proclemer A. Randomized crossover comparison of right atrial appendage pacing versus interatrial septum pacing for prevention of paroxysmal atrial fibrillation in patients with sinus bradycardia. Am Heart J 2001;142:1047–1055.CrossRefPubMedGoogle Scholar
- 41.Sweeney MO, Hellkamp AS, Ellenbogen KA, Greenspon AJ, Freedman RA, Lee KL, Lamas GA. for the Mode Selection Trial (MOST) Investigators: Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation 2003;107:2932–2937.CrossRefPubMedGoogle Scholar