Skip to main content
SpringerLink
Log in

Is Dual Defibrillator Better than Conventional DDD Pacing in Brady-Tachy Syndrome? Results of the ICARUS Trial (Internal Cardioversion Antitachypacing and Prevention: Resource Utilization Study)

  • Defibrillation
  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Aim of the study: To compare the impact of dual defibrillator versus conventional DDD pacing on quality of life and hospitalizations in patients with sinus node disease and recurrent symptomatic atrial fibrillation.

Study design: Prospective, parallel, controlled trial.

Methods: Sixty-three patients (41 M, mean age 71 ± 8 years) with sinus node disease and at least three symptomatic episodes of atrial fibrillation during the last year were enrolled. Thirty-one consecutive patients received a dual defibrillator (group A) and 32 standard DDD pacing (group B). In group A, 12 patients received an external remote-control device in order to shock themselves in case of atrial fibrillation, while 19 were scheduled for early in-hospital manual shock. Seventy-five percent had been hospitalized during the last year and 57% had required electrical cardioversion. Atrial fibrillation was persistent in 63.5% and paroxysmal in 37.5%. The follow-up lasted 1 year.

Results: Atrial fibrillation recurred in 83.3% in group A and 79.3% in group B (p = ns). Electrical cardioversion was applied in 54.8% in group A and in 21.9% in group B (p < 0.05). On the whole, 89.5% of electrical cardioversions were delivered in the defibrillator group (p < 0.0001). In the whole population 27.0% patients had cardiac-related hospitalization (31.2% in the pacemaker group and 22.6% in the defibrillator group, p = n.s.). In patients with persistent atrial fibrillation, cardiac-related hospitalization rate was significantly lower in the group A (0% vs. 30%, p < 0.05). Considering Symptom Check List, symptoms significantly improved in the whole population, but symptom number and frequency improved significantly only in the group A. Similarly, SF-36 questionnaire scores showed a little higher quality of life improvement in the group A.

Conclusions: Dual defibrillator showed consistent trends toward a higher effectiveness when compared with standard DDD pacing. Dual defibrillator was associated to reduced in-patient cardioversions and to better quality of life. All-cause hospitalizations were reduced only in patients with persistent atrial fibrillation

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Sutton R, Kenny RA. The natural history of sick sinus syndrome. PACE 1986;9:1110–1114.

    CAS  PubMed  Google Scholar 

  2. Camm AJ, Katritsis D. Ventricular pacing for sick sinus syndrome: A risky business? PACE 1990;13:695–699.

    CAS  PubMed  Google Scholar 

  3. Santini M, Alexidou G, Ansalone G, Cacciatore G, Cini R, Turitto G. Relation of prognosis in sick sinus syndrome to age, conduction defects and modes of permanent cardiac pacing. Am J Cardiol 1990;65:729–735.

    Article  CAS  PubMed  Google Scholar 

  4. Stangl K, Seitz K, Wirtzfeld A, Alt E, Blommer H. Differences between atrial single chamber pacing (AAI) and ventricular single chamber pacing (VVI) with respect to prognosis and antiarrhythmic effect in patients with sick sinus syndrome. PACE 1990;13:2080–2085.

    CAS  PubMed  Google Scholar 

  5. Feuer JM, Shandling AH, Messenger JC. Influence of cardiac pacing mode on the long-term development of atrial fibrillation. Am J Cardiol 1989;64:1376–1379.

    Article  CAS  PubMed  Google Scholar 

  6. Rosenqvist M, Brandt J, Schuller H. Long-term pacing in sinus node disease: Effects of stimulation mode on cardiovascular morbidity and mortality. Am Heart J 1988;116:16–22.

    Article  CAS  PubMed  Google Scholar 

  7. Hesselson AB, Parsonnet V, Bernstein AD, Bonavita GJ. Deleterious effects of long-term single-chamber ventricular pacing in patients with sick sinus syndrome: The hidden benefits of dual-chamber pacing. J Am Coll Cardiol 1992;19:1542–1549.

    CAS  PubMed  Google Scholar 

  8. Sgarbossa EB, Pinski SL, Maloney JD, Simmons TW, Wilkoff BL, Castle LW, Trohman RG. Chronic atrial fibrillation and stroke in paced patients with sick sinus syndrome. Relevance of clinical characteristics and pacing modalities. Circulation 1993;88:1045–1053.

    CAS  PubMed  Google Scholar 

  9. Santini M, Ricci R, Puglisi A, Mangiameli S, Proclemer A, Menozzi C, De Fabrizio G, Leoni G, Lisi F, de Seta F. Long-term haemodynamic and antiarrhythmic benefits of DDIR versus DDI pacing mode in sick sinus syndrome and chronotropic incompetence. G Ital Cardiol 1997;27:892–900.

    CAS  PubMed  Google Scholar 

  10. Andersen HR, Nielsen JC, Thomsen PEB, Thuesen L, Mortensen PT, Vesterlund T, Pedersen AK. Long-term follow up of patients from a randomised trial of atrial versus ventricular pacing for sick-sinus syndrome. Lancet 1997;350:1210–1216.

    Article  CAS  PubMed  Google Scholar 

  11. Mattioli AV, Vivoli D, Mattioli G. Influence of pacing modalities on the incidence of atrial fibrillation in patients without prior atrial fibrillation: A prospective study. Eur Heart J 1998;19:282–286.

    Article  CAS  PubMed  Google Scholar 

  12. Skanes AC, Krahn AD, Yee R, Klein GJ, Connolly SJ, Kerr CR, Gent M, Thorpe KE, Roberts RS for the CTOPP Investigators: Progression to chronic atrial fibrillation after pacing: The Canadian Trial of Physiologic Pacing. J Am Coll Cardiol 2001;38:167–172.

    Article  CAS  PubMed  Google Scholar 

  13. Lamas GA, Lee KL, Sweeney MO, Silverman R, Leon A, Yee R, Marinchak RA, Flaker G, Schron E, Orav EJ, Hellkamp AS, Goldman L, for the Mode Selection Trial in Sinus Node Dysfunction. Ventricular pacing or dual chamber pacing for sinus node dysfunction. N Engl J Med 2002;346:1854–1862.

    Article  PubMed  Google Scholar 

  14. Ricci R, Santini M, Puglisi A, Azzolini P, Capucci A, Pignalberi C, Boriani G, Botto GL, Spampinato A, Bellocci F, Proclemer A, Grammatico A, de Seta F. Impact of consistent atrial pacing algorithm on premature atrial complexe number and paroxysmal atrial fibrillation recurrences in brady-tachy syndrome: A randomized prospective cross over study. J Interv Card Electrophysiol 2001;5:33–44.

    Article  CAS  PubMed  Google Scholar 

  15. Friedman PA, Dijkman B, Warman EN, Xia HA, Mehra R, Stanton MS, Hamill SC, for the Worldwide Jewel AF Investigators. Atrial therapies reduce atrial arrhythmia burden in defibrillator patients. Circulation 2001;104:1023–1028.

    CAS  PubMed  Google Scholar 

  16. Ricci R, Pignalberi C, Disertori M, Capucci A, Padeletti L, Botto G, Boriani G, Miraglia F, de Santo T, Santini M. Antitachycardia pacing therapy to treat spontaneous atrial tachyarrhythmias: The 7250 Dual Defibrillator Italian Registry. Eur Heart J 2001;3(Suppl. P):P25–P32.

    Google Scholar 

  17. Wellens HJJ, Lau CP, Luderitz B, Akhtar M, Waldo AL, Camm AJ, Timmermans C, Tse HF, Jung W, Jordaens L, Ayers G. Atrioverter: an implantable device for the treatment of atrial fibrillation. Circulation 1998;98:1651–1656.

    CAS  PubMed  Google Scholar 

  18. Gold MR, Sulke N, Schwartzman DS, Mehra R, Euler DE, for the Worldwide Jewel AF-Only Investigators: Clinical experience with a dual chamber implantable cardioverter defibrillator to treat atrial tachyarrhythmias. J Cardiovasc Electrophysiol 2001;12:1247–1253.

    Article  CAS  PubMed  Google Scholar 

  19. Ricci R, Pignalberi C, Disertori M, Capucci A, Padeletti L, Botto G, Toscano S, Miraglia F, Grammatico A, Santini M. Efficacy of a dual chamber defibrillator with atrial antitachycardia functions in treating spontaneous atrial tachyarrhythmias in patients with life-threatening ventricular tachyarrhythmias. Eur Heart J 2002;23:1471–1479.

    Article  CAS  PubMed  Google Scholar 

  20. Adler SW, Wolpert C, Warman EN, Musley SK, Koehler JL, Euler DE for the Worldwide Jewel AF Investigators. Efficacy of pacing therapies for treating atrial tachyarrhythmias in patients with ventricular arrhythmias receiving a dual-chamber implantable cardioverter defibrillator. Circulation 2001;104:887–892.

    PubMed  Google Scholar 

  21. Wijffels MCEF, Kirchhof CJHJ, Dorland RD, Allessie MA. Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats. Circulation 1995;92:1954–1968.

    CAS  PubMed  Google Scholar 

  22. Savelieva I, Camm J. The results of pacing trials for the prevention and termination of atrial tachyarrhythmias: Is there any evidence of therapeutic breakthrough? J Interv Cardiac Electrophysiol 2003;8:103–115.

    Google Scholar 

  23. Jenkins LS, Bubien RS. Quality of life in patients with atrial fibrillation. Cardiol. Clin. 1996;14:597–606.

    CAS  PubMed  Google Scholar 

  24. Ware JE. The SF-36 health survey manual and interpretation guide. Boston, MA, The Health Institute, New England Medical Center; 1993.

  25. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med. Care 1992;30:473–483.

    PubMed  Google Scholar 

  26. McHorney CA, Ware JE, Raczek AE. The MOS 36-item short-form health (SF-36). II. Psychometric and clinical tests of validity in measuring physical and mental health conditions. Med. Care 1993;81:247–263.

    Google Scholar 

  27. McHorney CA, Ware JE, Lu JFR, Sherbourne CD. The MOS 36-item short-form health (SF-36), III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med. Care 1994;82:40–66.

    Google Scholar 

  28. Bubien RS, Kay GN, Jenkins LS. Test specifications for symptom checklist. Frequency and severity. 1993. Milwaukee, University of Wisconsin-Milwaukee.

  29. Tanigawa M, Fukatani M, Konoe A, Isomoto S, Kadena M, Hashiba K. Prolonged and fractionated atrial electrograms during sinus rhythm in patients with paroxismal atrial fibrillation and sick sinus node syndrome. J Am Coll Cardiol 1991;17:403–408.

    CAS  PubMed  Google Scholar 

  30. Centurion OA, Fukatani M, Konoe A, Tanigawa M, Shimizu A, Isomoto S, Kaibara M, Hashiba K. Different distribution of abnormal endocardial electrograms within the right atrium in patients with sick sinus syndrome. Br Heart J 1992;68:596–600.

    CAS  PubMed  Google Scholar 

  31. De Sisti A, Leclercq JF, Fiorello P, Manot S, Halimi F, Attuel P. Electrophysiologic characteristics of the atrium in sinus node dysfunction: Atrial refractoriness and conduction. J Cardiovasc Electrophysiol 2000;11:30–33.

    CAS  Google Scholar 

  32. De Sisti A, Attuel P, Manot S, Fiorello P, Halimi F, Leclercq JF. Electrophysiological determinants of atrial fibrillation in sinus node dysfunction despite atrial pacing. Europace 2000;2:304–311.

    CAS  Google Scholar 

  33. Stabile G, Senatore G, De Simone A, Turco P, Coltorti F, Nocerino P, Vitale DF, Chiariello M. Determinants of efficacy of atrial pacing in preventing atrial fibrillation recurrences. J Cardiovasc Electrophysiol 1999;10:2–9.

    CAS  PubMed  Google Scholar 

  34. Timmermans C, Levy S, Ayers GM, for the Metrix Investigators. Spontaneous episodes of atrial fibrillation after implantation of the Metrix atrioverter: Observations on treated and nontreated episodes. J Am Coll Cardiol 2000;35:1428–1433.

    Article  CAS  PubMed  Google Scholar 

  35. Tse HF, Lau CP, Yu CM, Lee KL, Michaud GF, Knight GP, Morady F, Strickberger SA. Effect of the implantable atrial defibrillator on the natural history of atrial fibrillation. J Cardiovasc Electrophysiol 1999;10:1200–1209.

    CAS  PubMed  Google Scholar 

  36. Ricci R, Quesada A, Pignalberi C, Roda J, Disertori M, Capucci A, Raviele A, Santini M. Dual defibrillator improves quality of life and decreases hospitalizations in patients with drug refractory atrial fibrillation. J Interv Card Electrophysiol 2004;10:85–92.

    Article  PubMed  Google Scholar 

  37. Jung W, Luderitz B. Quality of life in patients with atrial fibrillation. J Cardiovasc Electrophysiol 1998;9(Suppl.8):S177–S186.

    CAS  PubMed  Google Scholar 

  38. Herrmann C, vonzurMuhen F, Schaumann A, Buss U, Kemper S, Wantzen C, Gonska BD. Standardized assessment of psychological well-being and quality-of-life in patients with implanted defibrillators. Pacing Clin Electrophysiol 1997;20:95–103.

    CAS  PubMed  Google Scholar 

  39. Padeletti L, Santini M, Boriani G, Botto GL, Capucci A, Gulizia M, Ricci R, Spampinato A, Pieragnoli P, Warman E, Vimercati M, Grammatico A. Temporal variability of atrial tachyarrhythmia burden in bradycardia-tachycardia syndrome patients. Eur Heart J 2005;26:165–172.

    PubMed  Google Scholar 

  40. Padeletti L, Pieragnoli P, Ciapetti C, Colella A, Musilli N, Porciani MC, Ricci R, Pignalberi C, Santini M, Puglisi A, Azzolini P, Spampinato A, Martelli M, Capucci A, Boriani G, Botto G, Proclemer A. Randomized crossover comparison of right atrial appendage pacing versus interatrial septum pacing for prevention of paroxysmal atrial fibrillation in patients with sinus bradycardia. Am Heart J 2001;142:1047–1055.

    Article  CAS  PubMed  Google Scholar 

  41. Sweeney MO, Hellkamp AS, Ellenbogen KA, Greenspon AJ, Freedman RA, Lee KL, Lamas GA. for the Mode Selection Trial (MOST) Investigators: Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation 2003;107:2932–2937.

    Article  PubMed  Google Scholar 

  42. Boodhoo L, Mitchell A, Ujhelyi M, Sulke N. Improving the acceptability of the atrial defibrillator: Patient-activated cardioversion versus automatic night cardioversion with and without sedation (ADSAS 2). Pacing Clin Electrophysiol 2004;27:910–917.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiology, S. Filippo Neri Hospital, Via Martinotti, 20, Rome, 00135, Italy

    Massimo Santini FESC, FACC (Prof., MD), Renato Ricci, Carlo Pignalberi, Maurizio Russo, Barbara Magris, Nicoletta Grovale & Tiziana De Santo

Authors
  1. Massimo Santini FESC, FACC
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Renato Ricci
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carlo Pignalberi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maurizio Russo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Barbara Magris
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nicoletta Grovale
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tiziana De Santo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Massimo Santini FESC, FACC.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Santini, M., Ricci, R., Pignalberi, C. et al. Is Dual Defibrillator Better than Conventional DDD Pacing in Brady-Tachy Syndrome? Results of the ICARUS Trial (Internal Cardioversion Antitachypacing and Prevention: Resource Utilization Study). J Interv Card Electrophysiol 14, 159–168 (2005). https://doi.org/10.1007/s10840-006-6204-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-006-6204-3

Keywords

Search

Navigation