# Closed-loop stimulatie vermindert AHRE's versus conventionele rate-adaptieve pacing

*geplaatst 2024-07-02 · Atriumfibrilleren · Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · doi 10.1093/europace/euae175 · https://hartvaat.nl/2024/07/02/closed-loop-stimulatie-vermindert-ahre-s-versus-conventionele-rate-adaptieve-pac/*

Studie toonde dat closed-loop stimulatie (CLS) pacing minder atriale high-rate episodes veroorzaakt dan conventionele rate-adaptieve pacing. CLS biedt een fysiologischere hartfrequentierespons die het AF-risico kan verminderen.

## English: Closed loop stimulation reduces the incidence of atrial high-rate episodes compared with conventional rate-adaptive pacing in patients with sinus node dysfunctions.

This study showed that closed-loop stimulation pacing reduces atrial high-rate episodes compared with conventional rate-adaptive pacing, suggesting that physiological heart rate adaptation may have antiarrhythmic properties.

## Abstract (original, from the publication)

AIMS: Subclinical atrial fibrillation (AF) is associated with increased risk of progression to clinical AF, stroke, and cardiovascular death. We hypothesized that in pacemaker patients requiring dual-chamber rate-adaptive (DDDR) pacing, closed loop stimulation (CLS) integrated into the circulatory control system through intra-cardiac impedance monitoring would reduce the occurrence of atrial high-rate episodes (AHREs) compared with conventional DDDR pacing. METHODS AND RESULTS: Patients with sinus node dysfunctions (SNDs) and an implanted pacemaker or defibrillator were randomly allocated to dual-chamber CLS (n = 612) or accelerometer-based DDDR pacing (n = 598) 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). All AHREs were independently adjudicated using intra-cardiac electrograms. The incidence of the primary endpoint was lower in the CLS arm (50.6%) than in the DDDR arm (55.7%), primarily due to the reduction in AHREs lasting between 6 h and 7 days. Unadjusted site-stratified hazard ratio (HR) for CLS vs. DDDR was 0.84 [95% confidence interval (CI), 0.72-0.99; P = 0.035]. After adjusting for CHA2DS2-VASc score, the HR remained 0.84 (95% CI, 0.71-0.99; P = 0.033). In subgroup analyses of AHRE incidence, the incremental benefit of CLS was greatest in patients without atrioventricular block (HR, 0.77; P = 0.008) and in patients without AF history (HR, 0.73; P = 0.009). The contribution of stroke/TIA to the primary endpoint (1.3%) was low and not statistically different between study arms. CONCLUSION: Dual-chamber CLS in patients with SND is associated with a significantly lower AHRE incidence than conventional DDDR pacing.

Auteurs: Ennio C L Pisanò, Valeria Calvi, Miguel Viscusi, Antonio Rapacciuolo, Ludovico Lazzari, Luca Bontempi, Gemma Pelargonio, Giuseppe Arena, Vincenzo Caccavo, Chun-Chieh Wang, Béla Merkely, Lian-Yu Lin, Il-Young Oh, Emanuele Bertaglia, Davide Saporito, Maurizio Menichelli, Antonino Nicosia, Domenico M Carretta, Aldo Coppolino, Chi Keong Ching, Álvaro Marco Del Castillo, Xi Su, Martina Del Maestro, Daniele Giacopelli, Alessio Gargaro, Giovanni L Botto

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Bron: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, https://doi.org/10.1093/europace/euae175. Bijgewerkt 2026-07-03T13:30:04Z. 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.