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Title: Prospective randomized study to assess the efficacy of site and rate of atrial pacing on long-term progression of atrial fibrillation in sick sinus syndrome septal pacing for atrial fibrillation suppression evaluation (SAFE) study
Authors: Chu Pak Lau
Ngarmukos Tachapong
Chun Chieh Wang
Jing Feng Wang
Haruhiko Abe
Chi Woon Kong
Reginald Liew
Dong Gu Shin
Luigi Padeletti
You Ho Kim
Razali Omar
Kreingkrai Jirarojanakorn
Yoon Nyun Kim
Mien Cheng Chen
Charn Sriratanasathavorn
Muhammad Munawar
Ruth Kam
Jan Yow Chen
Yong Keun Cho
Yi Gang Li
Shu Lin Wu
Christophe Bailleul
Hung Fat Tse
The University of Hong Kong
Mahidol University
Chang Gung Memorial Hospital
Sun Yat-Sen University
University of Occupational and Environmental Health
Veterans General Hospital-Taipei
National Heart Centre, Singapore
Yeungnam University Medical Center
Universita degli Studi di Firenze
Asan Medical Center
Institut Jantung Negara Kuala Lumpur
Bhumibol Adulyadej Hospital
Keimyung University, Dongsan Medical Center
Chang Gung University
Harapan Kita Hospital
Changi General Hospital
China Medical University Taichung
Kyungpook National University Hospital
Shanghai Jiao Tong University
Guangdong General Hospital
St. Jude Medical
Keywords: Medicine
Issue Date: 13-Aug-2013
Citation: Circulation. Vol.128, No.7 (2013), 687-693
Abstract: Background-Atrial-based pacing is associated with lower risk of atrial fibrillation (AF) in sick sinus syndrome compared with ventricular pacing; nevertheless, the impact of site and rate of atrial pacing on progression of AF remains unclear. We evaluated whether long-term atrial pacing at the right atrial (RA) appendage versus the low RA septum with (ON) or without (OFF) a continuous atrial overdrive pacing algorithm can prevent the development of persistent AF. Methods and Results-We randomized 385 patients with paroxysmal AF and sick sinus syndrome in whom a pacemaker was indicated to pacing at RA appendage ON (n=98), RA appendage OFF (n=99), RA septum ON (n=92), or RA septum OFF (n=96). The primary outcome was the occurrence of persistent AF (AF documented at least 7 days apart or need for cardioversion). Demographic data were homogeneous across both pacing site (RA appendage/RA septum) and atrial overdrive pacing (ON/OFF). After a mean follow-up of 3.1 years, persistent AF occurred in 99 patients (25.8%; annual rate of persistent AF, 8.3%). Alternative site pacing at the RA septum versus conventional RA appendage (hazard ratio=1.18; 95% confidence interval, 0.79-1.75; P=0.65) or continuous atrial overdrive pacing ON versus OFF (hazard ratio=1.17; 95% confidence interval, 0.79-1.74; P=0.69) did not prevent the development of persistent AF. Conclusions-In patients with paroxysmal AF and sick sinus syndrome requiring pacemaker implantation, an alternative atrial pacing site at the RA septum or continuous atrial overdrive pacing did not prevent the development of persistent AF. Clinical Trial Registration-URL: Unique identifier: NCT00419640. © 2013 American Heart Association, Inc.
ISSN: 15244539
Appears in Collections:Scopus 2011-2015

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