Pacing the Ventricle: With Dual-Chamber Pacemakers, Less Is More

Dual-chamber pacemakers are routinely used to ensure atrioventricular synchrony in patients with sick-sinus syndrome. However, physiologic synchronization, which results in obligatory ventricular pacing, is hypothesized to have an adverse effect on ventricular pump function, increasing the risk for atrial fibrillation. Appropriate programming of the pacemaker is an important component of patient care. Might a strategy to minimize ventricular stimulation in dual-chamber pacing reduce AF risk? To find out, investigators randomized 1065 patients with dual-chamber pacemakers for sinus node dysfunction to either conventional programmed maintenance of physiologic AV interval and obligatory ventricular pacing or special programming to minimize ven…