{"id":"18bd75dd229d","type":"article","url":"https://hartvaat.nl/2023/10/21/minimalisatie-van-atriale-pacing-bij-sinusknoopziekte-vermindert-af/","title":"Minimalisatie van atriale pacing bij sinusknoopziekte vermindert AF","title_en":"Atrial pacing minimization in sinus node dysfunction and risk of incident atrial fibrillation: a randomized trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["cardiale-resynchronisatie","supraventriculaire-tachycardie"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehad564","source_url":"https://doi.org/10.1093/eurheartj/ehad564","authors":["Mads Brix Kronborg","Maria Hee Jung Park Frausing","Jerzy Malczynski","Sam Riahi","Jens Haarbo","Katja Fiedler Holm","Charlotte Ellen Larroudé","Andi Eie Albertsen","Lene Svendstrup","Ulrik Hintze","Ole Dyg Pedersen","Ulla Davidsen","Thomas Fischer","Jens Brock Johansen","Jens Kristensen","Christian Gerdes","Jens Cosedis Nielsen"],"significance":7,"published":"2023-10-21","source_date":"2023-10-21","image":"","kennis":["https://hartvaat.nl/kennis/ritmestoornissen/sport-en-ritmestoornissen/"],"congress":"","summary_en":"This randomized trial showed that minimizing atrial pacing in sinus node dysfunction reduces the risk of new-onset atrial fibrillation, suggesting that unnecessary atrial pacing may itself contribute to AF development.","created":"2026-07-03T10:30:38Z","updated":"2026-07-03T18:39:07Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial toonde dat minimalisatie van atriale pacing bij sinusknoopziekte het risico op incident AF vermindert. Minder pacing leidt tot minder remodelering en minder aritmie, wat de programmering van pacemakers beïnvloedt.","abstract_original":"BACKGROUND AND AIMS: High percentages of atrial pacing have been associated with an increased risk of atrial fibrillation. This study is aimed at evaluating whether atrial pacing minimization in patients with sinus node dysfunction reduces the incidence of atrial fibrillation. METHODS: In a nationwide, randomized controlled trial, 540 patients with sinus node dysfunction and an indication for first pacemaker implantation were assigned to pacing programmed to a base rate of 60 bpm and rate-adaptive pacing (DDDR-60) or pacing programmed to a base rate of 40 bpm without rate-adaptive pacing (DDD-40). Patients were followed on remote monitoring for 2 years. The primary endpoint was time to first episode of atrial fibrillation longer than 6 min. Secondary endpoints included longer episodes of atrial fibrillation, and the safety endpoint comprised a composite of syncope or presyncope. RESULTS: The median percentage of atrial pacing was 1% in patients assigned to DDD-40 and 49% in patients assigned to DDDR-60. The primary endpoint occurred in 124 patients (46%) in each treatment group (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.76-1.25, P = .83). There were no between-group differences in atrial fibrillation exceeding 6 or 24 h, persistent atrial fibrillation, or cardioversions for atrial fibrillation. The incidence of syncope or presyncope was higher in patients assigned to DDD-40 (HR 1.71, 95% CI 1.13-2.59, P = .01). CONCLUSIONS: Atrial pacing minimization in patients with sinus node dysfunction does not reduce the incidence of atrial fibrillation. Programming a base rate of 40 bpm without rate-adaptive pacing is associated with an increased risk of syncope or presyncope."}