{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T02:48:59Z","timestamp":1791946139640,"version":"4.3.4"},"reference-count":49,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2024,6,28]],"date-time":"2024-06-28T00:00:00Z","timestamp":1719532800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Biotronik SE & Co KG"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,7,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>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 \u22656 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\u20130.99; P = 0.035]. After adjusting for CHA2DS2-VASc score, the HR remained 0.84 (95% CI, 0.71\u20130.99; 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Dual-chamber CLS in patients with SND is associated with a significantly lower AHRE incidence than conventional DDDR pacing.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/europace\/euae175","type":"journal-article","created":{"date-parts":[[2024,6,28]],"date-time":"2024-06-28T08:12:20Z","timestamp":1719562340000},"source":"Crossref","is-referenced-by-count":12,"title":["Closed loop stimulation reduces the incidence of atrial high-rate episodes compared with conventional rate-adaptive pacing in patients with sinus node dysfunctions"],"prefix":"10.1093","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0187-0492","authenticated-orcid":false,"given":"Ennio C L","family":"Pisan\u00f2","sequence":"first","affiliation":[{"name":"Cardiology and Intensive Care Unit, Vito Fazzi Hospital , Lecce , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Calvi","sequence":"additional","affiliation":[{"name":"Cardiology, G. Rodolico\u2014San Marco University Hospital , Catania , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel","family":"Viscusi","sequence":"additional","affiliation":[{"name":"Clinical and Interventional Arrhythmology, Sant\u2019Anna e San Sebastiano Hospital , Caserta , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4739-7004","authenticated-orcid":false,"given":"Antonio","family":"Rapacciuolo","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Sciences, Federico II University of Naples , Naples , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9382-840X","authenticated-orcid":false,"given":"Ludovico","family":"Lazzari","sequence":"additional","affiliation":[{"name":"Clinical and Interventional Arrhythmology, Santa Maria Hospital , Terni , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Bontempi","sequence":"additional","affiliation":[{"name":"Cardiology, Bolognini Hospital , Seriate , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3236-3458","authenticated-orcid":false,"given":"Gemma","family":"Pelargonio","sequence":"additional","affiliation":[{"name":"Arrhythmology, Fondazione Policlinico Gemelli IRCCS Universit\u00e0 Cattolica del Sacro Cuore , Roma , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0266-6493","authenticated-orcid":false,"given":"Giuseppe","family":"Arena","sequence":"additional","affiliation":[{"name":"Cardiology and Intensive Care Unit, Apuane New Hospital , Massa , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Caccavo","sequence":"additional","affiliation":[{"name":"Cardiology and Intensive Care Unit, Miulli Regional Hospital , Acquaviva delle Fonti , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Chieh","family":"Wang","sequence":"additional","affiliation":[{"name":"Cardiology, Chang Gung Memorial Hospital\u2014Linkou\u2014CGMH , Taipei , Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6514-0723","authenticated-orcid":false,"given":"B\u00e9la","family":"Merkely","sequence":"additional","affiliation":[{"name":"Heart and Vascular Centre, Semmelweis University , Budapest , Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7505-6429","authenticated-orcid":false,"given":"Lian-Yu","family":"Lin","sequence":"additional","affiliation":[{"name":"Cardiology, National Taiwan University Hospital , Taipei , Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5584-605X","authenticated-orcid":false,"given":"Il-young","family":"Oh","sequence":"additional","affiliation":[{"name":"Cardiology, Seoul National University Bundang Hospital , Seongnam , Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3878-2904","authenticated-orcid":false,"given":"Emanuele","family":"Bertaglia","sequence":"additional","affiliation":[{"name":"Cardiology, Camposampiero Hospital , Padova , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9478-6950","authenticated-orcid":false,"given":"Davide","family":"Saporito","sequence":"additional","affiliation":[{"name":"Cardiology, Infermi Hospital , Rimini , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Menichelli","sequence":"additional","affiliation":[{"name":"Cardiology, F. Spaziani Hospital , Frosinone , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7862-5751","authenticated-orcid":false,"given":"Antonino","family":"Nicosia","sequence":"additional","affiliation":[{"name":"Cardiology, Giovanni Paolo II Hospital , Ragusa , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico M","family":"Carretta","sequence":"additional","affiliation":[{"name":"Cardiology and Intensive Care Unit, Policlinico Consorziale , Bari , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9937-9940","authenticated-orcid":false,"given":"Aldo","family":"Coppolino","sequence":"additional","affiliation":[{"name":"Cardiology and Intensive Care Unit, Elecrophysiology, SS Annunziata Hospital , Savigliano, Cuneo , 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