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Background <p>Single chamber atrial pacing (AAI) provides a disease-specific treatment for sick sinus syndrome (SSS) but has largely been replaced by DDD pacing. With the advent of leadless atrial pacemakers (PM), there is growing interest in long-term follow-up data in patients with SSS and an AAI pacemaker.</p> Purpose <p>To assess the incidence of system upgrade in patients treated with AAI-PM for SSS during long-term follow-up.</p> Methods <p>This is an analysis of prospectively enrolled patients undergoing implantation of an AAI-PM. Wenckebach block point (WBP) was measured at implantation and serially during follow up.</p> Results <p>We included 178 patients (58% female, median age at implantation 77 [71–83] years). The median follow-up duration was 6.5 [2.0–9.7] years. Twenty-three patients (13%) received a system upgrade to a DDD system, corresponding to a yearly upgrade rate of 2.0%. Median time to system upgrade was 5.2 [1.6–8.7] years. Reasons for system upgrade were higher-degree AVB (39%), atrial arrhythmias (35%), low WBP (17%), and syncope (9%). Median WBP at implantation was 130 [120–140] bpm, showing a significant decline over time in the upgrade-group compared to the rest of the cohort with 103 [91–130] bpm vs. 130 [120–130] bpm (<i>p</i> = 0.011).</p> Conclusion <p>In this cohort of patients undergoing AAI-PM implantation for SSS, upgrade to a DDD system was low during long-term follow-up. Therefore, AAI pacing for the treatment of SSS may be considered a patient-tailored treatment option, especially in light of novel leadless pacing therapies.</p> Graphical abstract <p>Central Illustration: AF = atrial fibrillation; AT = atrial tachycardia; AVB = atrioventricular block; WBP = Wenckebach block point; AAI = single-chamber atrial stimulation</p> <p></p>

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Long-term follow up of single-chamber atrial pacing—system upgrade and Wenckebach block point behavior: potential implications for leadless AAI pacing?

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年5月16日

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  • Patrick Badertscher,
  • Rebecca Arnet,
  • Corinne Isenegger,
  • Behnam Subin,
  • Sven Knecht,
  • Jessica Trussardi,
  • Philipp Krisai,
  • Felix Mahfoud,
  • Christian Sticherling,
  • Beat Schär,
  • Michael Kühne

摘要

Background

Single chamber atrial pacing (AAI) provides a disease-specific treatment for sick sinus syndrome (SSS) but has largely been replaced by DDD pacing. With the advent of leadless atrial pacemakers (PM), there is growing interest in long-term follow-up data in patients with SSS and an AAI pacemaker.

Purpose

To assess the incidence of system upgrade in patients treated with AAI-PM for SSS during long-term follow-up.

Methods

This is an analysis of prospectively enrolled patients undergoing implantation of an AAI-PM. Wenckebach block point (WBP) was measured at implantation and serially during follow up.

Results

We included 178 patients (58% female, median age at implantation 77 [71–83] years). The median follow-up duration was 6.5 [2.0–9.7] years. Twenty-three patients (13%) received a system upgrade to a DDD system, corresponding to a yearly upgrade rate of 2.0%. Median time to system upgrade was 5.2 [1.6–8.7] years. Reasons for system upgrade were higher-degree AVB (39%), atrial arrhythmias (35%), low WBP (17%), and syncope (9%). Median WBP at implantation was 130 [120–140] bpm, showing a significant decline over time in the upgrade-group compared to the rest of the cohort with 103 [91–130] bpm vs. 130 [120–130] bpm (p = 0.011).

Conclusion

In this cohort of patients undergoing AAI-PM implantation for SSS, upgrade to a DDD system was low during long-term follow-up. Therefore, AAI pacing for the treatment of SSS may be considered a patient-tailored treatment option, especially in light of novel leadless pacing therapies.

Graphical abstract

Central Illustration: AF = atrial fibrillation; AT = atrial tachycardia; AVB = atrioventricular block; WBP = Wenckebach block point; AAI = single-chamber atrial stimulation