Clinical Trial Results: Closed Loop Stimulation in Patients with Sinus Node Dysfunctions
Practical Solutions and Value
Closed loop stimulation (CLS) integrated into the circulatory control system through intra-cardiac impedance monitoring reduces the occurrence of atrial high-rate episodes (AHREs) compared with conventional rate-adaptive pacing in patients with sinus node dysfunctions (SNDs).
Patients with SNDs and an implanted pacemaker or defibrillator were randomly allocated to dual-chamber CLS or accelerometer-based DDDR pacing and followed for 3 years. The primary endpoint was time to the composite endpoint of the first AHRE lasting ≥6 min, stroke, or transient ischaemic attack (TIA). The incidence of the primary endpoint was lower in the CLS arm than in the DDDR arm, primarily due to the reduction in AHREs lasting between 6 h and 7 days.
Subgroup analyses showed that the incremental benefit of CLS was greatest in patients without atrioventricular block and in patients without AF history. The contribution of stroke/TIA to the primary endpoint was low and not statistically different between study arms.
Dual-chamber CLS in patients with SND is associated with a significantly lower AHRE incidence than conventional DDDR pacing.
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