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首页> 外文期刊>PACE: Pacing and clinical electrophysiology >Pacemaker mode selection: the evidence from randomized trials.
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Pacemaker mode selection: the evidence from randomized trials.

机译：起搏器模式选择：来自随机试验的证据。

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The evidence base for pacing, specifically with regards to outcome-based randomized trials, is only beginning to emerge. At present, the guidelines for pacing in sinus node dysfunction (SND), atrioventricular block (AVB), and vasovagal syncope are largely based on observational, not randomized studies. The findings from observational studies that physiological pacing was associated with reduced mortality, fewer strokes, less heart failure, and less AF when compared with ventricular pacing, were not uniformly supported by the early randomized trials of a relatively small sample size. Thus, it has become increasingly clear that large scale randomized trials are necessary to measure reliably the benefit, if any, of progressively more expensive and complex pacemakers. To provide reliable answers to these important questions, three large multicenter randomized trials in Canada, the United Kingdom, and the United States have been designed and conducted. The present review analyzed the results of completed randomized trials on pacemaker mode selection. To date, > 6,000 patients requiring permanent pacing to prevent bradycardia have been randomized; among these, dual chamber pacing did not prevent stroke or improve survival when compared with ventricular pacing. However, dual chamber pacing led to a moderate reduction of incident and chronic AF, reduced symptoms of heart failure in patients with SND, prevented pacemaker syndrome, and modestly improved quality-of-life. Further, a 5-10% reduction in mortality by atrial-based pacing cannot be excluded based on the results of the analyzed trials. The availability of data from ongoing randomized trials and their meta analysis should complete the totality of evidence during the next several years.
机译：起搏的证据基础，尤其是基于结果的随机试验方面的证据基础才刚刚出现。目前，窦房结功能障碍（SND），房室传导阻滞（AVB）和血管迷走性晕厥起搏的指南主要基于观察性研究，而非随机研究。观察性研究的结果表明，与心室起搏相比，生理起搏与死亡率降低，卒中少，心力衰竭和房颤少有关，早期随机试验的样本量相对较小并不能统一支持。因此，越来越明显的是，必须进行大规模的随机试验来可靠地衡量逐渐昂贵和复杂的起搏器的益处（如果有）。为了提供对这些重要问题的可靠答案，已经设计并进行了加拿大，英国和美国的三项大型多中心随机试验。本综述分析了关于起搏器模式选择的完整随机试验的结果。迄今为止，已经有超过6,000名需要永久起搏以预防心动过缓的患者被随机分配。其中，与心室起搏相比，双腔起搏并不能预防卒中或改善生存率。然而，双腔起搏可适度降低事件和慢性房颤的发生率，减轻SND患者的心力衰竭症状，预防起搏器综合征，并适度改善生活质量。此外，基于分析试验的结果，不能排除通过心房起搏使死亡率降低5-10％。来自正在进行的随机试验及其荟萃分析的数据可用性将在未来几年内完成全部证据。

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