Objective To evaluate the effectiveness and safety of AAI pacing mode versus DDD pacing mode for treating sick sinus syndrome (SSS).
Methods We electronically searched CENTRAL (Issue 2, 2009), MEDLINE (1980 to June 2009), EMbase (1980 to June 2009) and CBM (1990 to June 2009). Randomized controlled trials (RCTs), quasi- RCTs and cross-over studies were identified and assessed, and then RevMan 5.0 software was used to perform metaanalysis.
Results A total of 509 patients of six parallel and two crossover RCTs were identified, and the quality of reporting was found poor. Studies showed a statistically significant preference to AAI pacing mode for the reduction of left atrial diameter (MD=2.09, 95%CI 0.22 to 3.97), left ventricular end-diastolic diameter (MD=3.00, 95%CI –1.58 to 7.58), the prevention atrial fibrillation (P=0.026) and the improvement of life quality (P lt;0.05), but with more replacement or remodulation. Non-significant preference was shown to the prevention of all-cause mortality (P=0.51), cardiovascular mortality (P=0.43), stroke (P=0.32) and heart failure (P=0.17), the reduction of left ventricular end-systolic diameter (MD=1.21, 95%CI –0.85 to 3.28) and left ventricular ejection fraction (MD= –2.91, 95%CI –6.53 to 0.70). No significant adverse effects were reported.
Conclusion The review shows a trend towards AAI pacing mode compared with DDD pacing mode in terms of effectiveness. However, because of the high bias risk of the included trials, the evidence is insufficient, so more large-sample and high-quality RCTs are needed.
Citation：
WANG Han,WU Linna,CUI Kai,WANG Guihua,TIAN Peng,DENG Juelin. DDD versus AAI Pacemakers for Sick Sinus Syndrome: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2010, 10(5): 558-563. doi: 10.7507/1672-2531.20100449
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Copyright © the editorial department of Chinese Journal of Evidence-Based Medicine of West China Medical Publisher. All rights reserved
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Kainz W. Sick sinus syndrome indication: AAI/R versus DDD/R. Wien Med Wochenschr, 2000, 150(19-21): 407-409.
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Dretzke J, Toff WD, Lip GYH, et al. Dual chamber versus single chamber ventricular pacemakers for sick sinus syndrome and atrioventricular block. Cochrane Database of Systematic Reviews, Issue 2, 2009.
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Matthijs FM, Frits WP, TheoA, et al. Asynchronous electrical activation induces asymmetrical hypertrophy of the left ventricular wall. Circulation, 1998, 98: 588-595.
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| 4. |
Albertsen AE, Nielsen JC, Poulsen SH, et al. DDD(R)-pacing, but not AAI(R)-pacing induces left ventricular desynchronization in patients with sick sinus syndrome: tissue-Doppler and 3D echocardiographic evaluation in a randomized controlled comparison. Europace, 2008, 10(2): 127-133.
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| 5. |
Bernhard S, Kindermann M, Schatzer-Klotz D, et al. AAIR versus DDDR pacing in the bradycardia tachycardia syndrome: a prospective, randomized, double-blind, crossover trial. Pacing Clin Electrophysiol, 2001, 24(11): 1585-1595.
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| 6. |
Kristensen L, Nielsen JC, Mortensen PT, et al. Incidence of atrial fibrillation and thromboembolism in a randomised trial of atrial versus dual chamber pacing in 177 patients with sick sinus syndrome. Heart, 2004, 90(6):661-666.
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| 7. |
Nielsen JC, Bottcher M, Nielsen TT, et al. Regional myocardial blood flow in patients with sick sinus syndrome randomized to long-term single chamber atrial or dual chamber pacing--effect of pacing mode and rate. J Am Coll Cardiol, 2000, 35(6):1453-1461.
|
| 8. |
Nielsen JC, Kristensen L, Andersen HR, et al. A randomized comparison of atrial and dual-chamber pacing in 177 consecutive patients with sick sinus syndrome: echocardiographic and clinical outcome. J Am Coll Cardiol, 2003, 42(4):614-623.
|
| 9. |
陈若菡, 刘志敏, 唐闽, 等. 不同起搏方式对病态窦房结综合征患者生活质量的长期影响. 中国循环杂志, 2008, 23(5): 370-373.
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| 10. |
任学军, 韩智红, 汪烨, 等. 一种新的双腔起搏模式-AAIsafeR与DDD模式的对比临床研究. 中国心脏起搏与心电生理杂志, 2008, 22(4): 310-313.
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| 11. |
赵福海, 韩明华, 赵玲, 等. AAI与DDD起搏方式对患者心功能的影响. 中国心脏起搏与心电生理杂志, 2005, 19(3): 178.
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- 1. Kainz W. Sick sinus syndrome indication: AAI/R versus DDD/R. Wien Med Wochenschr, 2000, 150(19-21): 407-409.
- 2. Dretzke J, Toff WD, Lip GYH, et al. Dual chamber versus single chamber ventricular pacemakers for sick sinus syndrome and atrioventricular block. Cochrane Database of Systematic Reviews, Issue 2, 2009.
- 3. Matthijs FM, Frits WP, TheoA, et al. Asynchronous electrical activation induces asymmetrical hypertrophy of the left ventricular wall. Circulation, 1998, 98: 588-595.
- 4. Albertsen AE, Nielsen JC, Poulsen SH, et al. DDD(R)-pacing, but not AAI(R)-pacing induces left ventricular desynchronization in patients with sick sinus syndrome: tissue-Doppler and 3D echocardiographic evaluation in a randomized controlled comparison. Europace, 2008, 10(2): 127-133.
- 5. Bernhard S, Kindermann M, Schatzer-Klotz D, et al. AAIR versus DDDR pacing in the bradycardia tachycardia syndrome: a prospective, randomized, double-blind, crossover trial. Pacing Clin Electrophysiol, 2001, 24(11): 1585-1595.
- 6. Kristensen L, Nielsen JC, Mortensen PT, et al. Incidence of atrial fibrillation and thromboembolism in a randomised trial of atrial versus dual chamber pacing in 177 patients with sick sinus syndrome. Heart, 2004, 90(6):661-666.
- 7. Nielsen JC, Bottcher M, Nielsen TT, et al. Regional myocardial blood flow in patients with sick sinus syndrome randomized to long-term single chamber atrial or dual chamber pacing--effect of pacing mode and rate. J Am Coll Cardiol, 2000, 35(6):1453-1461.
- 8. Nielsen JC, Kristensen L, Andersen HR, et al. A randomized comparison of atrial and dual-chamber pacing in 177 consecutive patients with sick sinus syndrome: echocardiographic and clinical outcome. J Am Coll Cardiol, 2003, 42(4):614-623.
- 9. 陈若菡, 刘志敏, 唐闽, 等. 不同起搏方式对病态窦房结综合征患者生活质量的长期影响. 中国循环杂志, 2008, 23(5): 370-373.
- 10. 任学军, 韩智红, 汪烨, 等. 一种新的双腔起搏模式-AAIsafeR与DDD模式的对比临床研究. 中国心脏起搏与心电生理杂志, 2008, 22(4): 310-313.
- 11. 赵福海, 韩明华, 赵玲, 等. AAI与DDD起搏方式对患者心功能的影响. 中国心脏起搏与心电生理杂志, 2005, 19(3): 178.
