Journal of Mahatma Gandhi University of Medical Sciences and Technology

Register      Login

VOLUME 7 , ISSUE 1 ( January-April, 2022 ) > List of Articles


Single-center Experience of AAIR Pacemakers for Sinus Node Dysfunction

Rajeev Sharma, Archit Dahiya, Manas Thakur, Piyush Joshi, Aniruddh Pratap

Keywords : AAIR, Pacemaker, Sinus node dysfunction

Citation Information : Sharma R, Dahiya A, Thakur M, Joshi P, Pratap A. Single-center Experience of AAIR Pacemakers for Sinus Node Dysfunction. J Mahatma Gandhi Univ Med Sci Tech 2022; 7 (1):4-6.

DOI: 10.5005/jp-journals-10057-0192

License: CC BY-NC 4.0

Published Online: 31-08-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Introduction: The choice of pacing mode in sinus node dysfunction in patients is still up for debate. Patients with atrial pacing (AAI/AAIR) in comparison to ventricular pacing (VVI/VVIR) have fewer chances of developing atrial fibrillation, stroke, and heart failure. Dual-chamber pacing (DDD/DDDR) is also associated with significantly less atrial fibrillation and less heart failure hospitalization, but various trials have failed to show a survival benefit in relation to ventricular pacing alone. We report about the use of AAIR pacemaker implantation for sinus node dysfunction in 15 adult patients and analyze the clinical characteristics and short-term outcomes of these patients. Materials and methods: All adult patients (18 years or above) who underwent AAIR pacemaker implantation for sinus node dysfunction at the Department of Cardiology, Mahatma Gandhi Hospital, Jaipur between 1st June 2018 and 31st August 2021 were included in the study for retrospective analysis of clinical characteristics and short-term outcome of these patients. This was a retrospective observational study. Prior approval was taken before the start of the study from the Institute Ethics Committee. Results: In our study, the mean age was 63 years and 66% of patients were females. Hypertension was present in 46% of patients and diabetes was seen in 33% of patients. About 26% of patients were having coronary artery disease (CAD). The mean LVEF in the study was 54%. Regarding the indication of AAIR pacemaker, 26% had inappropriate sinus bradycardia, 53% had significant sinus pause, and 20% had bradycardia-tachycardia syndrome. The procedure-related complication was not reported in our study. No change in the pacing mode was required in all 15 patients. Two patients developed episodes of paroxysmal AF on follow-up. No deaths were reported on short-term follow-up. Conclusion: The development of AV blocks is rare in sinus node dysfunction patients. The optimal choice of pacing in these patients is the atrial (AAI/AAIR) pacemaker. It is the safest and provides the best cost-to-benefit ratio when compared to a dual-chamber pacemaker. Hence, atrial pacing should be preferred in sinus node dysfunction patients in the absence of atrioventricular blocks.

PDF Share
  1. Andersen HR, Cosedis JN, Thomsen PL, et al. Long-term follow up of patients from a randomised trial of atrial versus ventricular pacing for sick-sinus syndrome. Lancet 1997;350(9086):1210–1216. DOI: 10.1016/S0140-6736(97)03425-9
  2. Santini M, Alexidou G, Ansalone G, et al. Relation of prognosis in sick sinus syndrome to age, conduction defects and modes of permanent cardiac pacing. Am J Cardiol 1990;65(11):729–735. DOI: 10.1016/0002-9149(90)91379-k
  3. Simon AB, Zloto AE. Symptomatic sinus node disease: natural history after permanent ventricular pacing. Pacing Clin Electrophysiol 1979;2(3):305–314. DOI: 10.1111/j.1540-8159.1979.tb03650.x
  4. Conolly SJ, Kerr CR, Gent M, et al. Effects of physiologic pacing versus ventricular pacing on the risk of stroke and death due to cardiovascular causes. N Engl J Med 2000:342(19):1385–1391. DOI: 10.1056/NEJM200005113421902
  5. Barold S. Permanent single chamber atrial pacing is obsolete. Pacing Clin Electrophysiol 2001;24(3):271–275. DOI: 10.1046/j.1460-9592.2001.00271.x
  6. Santini M, Ricci R. Is AAI or AAIR still a viable mode of pacing. Pacing Clin Electrophysiol 2001;24(3):276–281. DOI: 10.1046/j.1460-9592.2001.00276.x
  7. Goicolea de Oro A, López L, Pastor A, et al. Resultados a largo plazo de la estimulación auricular permanente en la enfermedad del nodo sinusal. Rev Esp Cardiol 1997;50(7):474–479
  8. Markewitz A, Hemmer W, Weinhold C. Complications in dual chamber pacing: a six year experience. Pacing Clin Electrophysiol 1986;9(6):1014–1018.
  9. Rosenqvist M, Isaaz K, Botvinick E, et al. Relative importance of activation sequence compared to AV synchrony in left ventricular function. Am J Cardiol 1991;67(2):148–156. DOI: 10.1016/0002-9149(91)90437-p
  10. Rediker DE, Eagle KA, Homma S, et al. Clinical and hemodynamic comparison of VVI versus DDD pacing in patients with DDD pacemakers. J Am Coll Cardiol 1986;61(4): 323–329. DOI: 10.1016/0002-9149(88)90938-1
  11. Kristensen L, Nielsen JC, Pedersen AK, et al. AV Block and changes in pacing mode during long term follow up of 399 consecutive patients with sick sinus syndrome treated with an AAI/AAIR pacemaker. Pacing Clin Electrophysiol 2001;24(3):358–365. DOI: 10.1046/j.1460-9592.2001.00358.x
  12. Lee MA, Dae MW, Langberg JJ, et al. Effects of long-term right ventricular apical pacing on left ventricular perfusion, inervation, function and histology. J Am Coll Cardiol 1994;24(1):225–232. DOI: 10.1016/0735-1097(94)90567-3
  13. Rosenqvist M, Bergfeldt L, Haga Y. The effect of ventricular activation sequence on cardiac performance during pacing. Pacing Clin Electrophysiol 1996;19(9):1279–1286. DOI: 10.1111/j.1540-8159.1996.tb04205.x
  14. Bedotto J, Grayburn P, Black WH, et al. Alterations in left ventricular relaxation during atrioventricular pacing in humans. J Am Coll Cardiol 1990;15(3):658–664. DOI: 10.1016/0735-1097(90)90642-3
  15. Tse H, Lau C. Long term effect of right ventricular pacing on myocardial perfusion and function. J Am Coll Cardiol 1997;29(4):744–749. DOI: 10.1016/s0735-1097(96)00586-4
  16. Nielsen JC, Bottcher M, Nielsen TT, et al. Regional myocardial blood flow in patients with sick sinus syndrome randomised 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. DOI: 10.1016/s0735-1097(00)00593-3
  17. Nielsen JC, Andersen HR, Thomsen PE, et al. Heart failure and echocardiographic changes during long-term follow up of patients with sick sinus syndrome randomised to single chamber atrial or ventricular pacing. Circulation 1998;97(10):987–995. DOI: 10.1161/01.cir.97.10.987
  18. Morinigo JL, Arribas A, Ledesma C, et al. Clinical safety and efficacy of single-chamber atrial pacing in sick sinus syndrome: long-term follow-up. Rev Esp Cardiol 2002;55(12):1267–1272. DOI: 10.1016/s0300-8932(02)76799-7
  19. Masumoto H, Ueda Y, Kato R, et al. Long-term clinical performance of AAI pacing in patients with sick sinus syndrome: a comparison with dual-chamber pacing. Europace 2004;6(5):444–450. DOI: 10.1016/j.eupc.2004.05.003
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.