SSS Patients: Atrial or Dual-Chamber Pacing?

  • P. Dini
  • E. Adinolfi
  • A. Avella
  • F. Laurenzi
  • A. Pappalardo
Conference paper


Symptomatic patients with sick sinus syndrome (SSS) are candidates for permanent pacemaker implantation. Single-chamber atrial (AAI) or dual-chamber (DDD) pacing rather than single-chamber ventricular (VVI) pacing is the recommended pacing mode, with rate response (-R) if appropriate [1]. Most retrospective studies have demonstrated that mortality is greater in VVI paced patients and that atrial-based pacing is hemodynamically superior and associated with a lower rate of atrial fibrillation (AF) and thromboembolic complications [2–6]. Other observational studies comparing physiological (AAI or DDD) with VVI pacing, while they confirmed that VVI pacing was an independent predictor of AF and stroke, did not identify any difference in mortality and heart failure incidence between the two groups [7–9].


Ventricular Pace Atrial Pace Sick Sinus Syndrome Sinus Node Dysfunction Pace Modality 
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  1. 1.
    Gregoratos G, Cheitlin MD, Conill AE et al (1998) ACC/AHA guidelines for implantation of cardiac pacemakers and antiarrhythmia devices: executive summary. Circulation 97:1325–1335PubMedCrossRefGoogle Scholar
  2. 2.
    Hesselson AB, Parsonet V, Bernstein A et al (1992) Deleterious effects of long-term single-chamber ventricular pacing in patients with sick sinus syndrome: the hidden benefits of dual chamber pacing. J Am Coll Cardiol 19:1542–1549PubMedCrossRefGoogle Scholar
  3. 3.
    Paxinos G, Kastritis D, Kakouros S et al (1998) Long term effect of VVI pacing on atrial and ventricular function in patients with sick sinus syndrome. Pacing Clin Electrophysiol 21:728–734PubMedCrossRefGoogle Scholar
  4. 4.
    Rosenqvist M, Brandt J, Schuller H (1988) Long term pacing in sinus node disease: effects of stimulation mode on cardiovascular morbidity and mortality. Am Heart J 116:16–22PubMedCrossRefGoogle Scholar
  5. 5.
    Stangl K, Seitz K, Wirtzfeld A et al (1990) Differences between atrial single chamber pacing (AAI) and ventricular single chamber pacing (VVI) with respect to prognosis and antiarrhythmic effect in patients with sick sinus syndrome. Pacing Clin Electrophysiol 13:2080–2085PubMedCrossRefGoogle Scholar
  6. 6.
    Santini M, Alexidou G, Ansalone G et al (1990) Relation of prognosis in sick sinus syndrome to age, conduction defects and modes of permanent cardiac pacing. Am J Cardiol 65:729–735PubMedCrossRefGoogle Scholar
  7. 7.
    Sgarbossa EB, Pinski SL, Maloney JD et al (1993) Chronic atrial fibrillation and stroke in paced patients with sick sinus syndrome. Relevance of clinical characteristics and pacing modalities. Circulation 88:1045–1053Google Scholar
  8. 8.
    Sgarbossa EB, Pinski SL, Maloney JD (1993) The role of pacing modality in determining long-term survival in the sick sinus syndrome. Ann Intern Med 119:359–365PubMedGoogle Scholar
  9. 9.
    Sgarbossa EB, Pinski SL, Trohman RG et al (1994) Single-chamber ventricular pacing is not associated with worsening heart failure in sick sinus syndrome. Am J Cardiol 73:693–697PubMedCrossRefGoogle Scholar
  10. 10.
    Andersen HR, Thuesen L, Bagger JP et al (1994) Prospective randomized trial of atrial versus ventricular pacing in sick sinus syndrome. Lancet 344:1523–1528PubMedCrossRefGoogle Scholar
  11. 11.
    Andersen HR, Nielsen JC, Thomsen PEB et al (1997) Long term follow-up of patients from a randomized trial of atrial versus ventricular pacing for sick sinus syndrome. Lancet 350:1210–1216PubMedCrossRefGoogle Scholar
  12. 12.
    Lamas GA, Orav EJ, Stambler BS et al (1998) Quality of life and clinical outcomes in elderly patients treated with ventricular pacing as compared with dual-chamber pacing. N Engl J Med 338:1097–1104PubMedCrossRefGoogle Scholar
  13. 13.
    Charles RG, McComb JM (1997) Systematic trial of pacing to prevent atrial fibrillation. Heart 78:224–225PubMedGoogle Scholar
  14. 14.
    Lamas GA (1997) Pacemaker mode selection and survival. A plea to apply the priciples of evidence based medicine to cardiac pacing practice. Heart 78:218–220PubMedGoogle Scholar
  15. 15.
    Marshall HJ, Gammage MD, Griffith MJ (1998) AAI pacing for sick sinus syndrome: first choice on all counts. Heart 80:315–316PubMedGoogle Scholar
  16. 16.
    AIAC Associazione Italiana di Aritmologia e Cardiostimolazione (1997) Registro Italiano Pacemaker e Defibrillatori. Associazione Italiana di Aritmologia e Cardiostimolazione, Roma, Bollettino periodico: registrazioni pacemaker gennaiodicembreGoogle Scholar
  17. 17.
    Rosen KM, Loeb HS, Sinno MZ et al (1971) Cardiac conduction in patients with symptomatic sinus node disease. Circulation 43:836–851PubMedCrossRefGoogle Scholar
  18. 18.
    Sutton R, Kenny RA (1986) The natural history of sick sinus syndrome. Pacing Clin Electrophysiol 9:1110–1114PubMedCrossRefGoogle Scholar
  19. 19.
    Bertholet M, Demoulin JC, Fourny J et al (1983) Natural evolution of atrioventricular conduction in patients with sick sinus syndrome treated by atrial demand pacing: a study of 26 cases. Acta Cardiol 38:227–232PubMedGoogle Scholar
  20. 20.
    Haywood GA, Ward J, Ward DE et al (1990) Atrioventricular Wenckebach point and progression to atrioventricular block in sinoatrial disease. Pacing Clin Electrophysiol 13:2054–2058PubMedCrossRefGoogle Scholar
  21. 21.
    Rosenqvist M, Obel IWP (1989) Atrial pacing and the risk for AV block: is there a time for change in attitude? Pacing Clin Electrophysiol 12:97–101PubMedGoogle Scholar
  22. 22.
    Clarke KW, Connelly DT, Charles RG (1998) Single chamber atrial pacing: an underused and cost-effective pacing modality in sinus node disease. Heart 80:387–389PubMedGoogle Scholar
  23. 23.
    Brandt J, Anderson H, Fahraeus T et al (1992) Natural history of sinus node disease treated with atrial pacing in 213 patients: implication for selection of stimulation mode. J Am Coll Cardiol 20:633–639PubMedCrossRefGoogle Scholar
  24. 24.
    Andersen HR, Nielsen JC, Thomsen PE et al (1998) Atriventricular conduction during long-term follow-up of patients with sick sinus syndrome. Circulation 98:1315–1321PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2000

Authors and Affiliations

  • P. Dini
    • 1
  • E. Adinolfi
    • 1
  • A. Avella
    • 1
  • F. Laurenzi
    • 1
  • A. Pappalardo
    • 1
  1. 1.Dipartimento di Scienze CardiologicheOspedale S.CamilloRomeItaly

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