All concepts, explanations, trials, and studies have been
re-written in plain English and may contain errors. I am
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ADEPT - Aggressive Pacing Not Needed for Most Patients

June 6, 2003 - This is from the ADEPT trial reported at the
NASPE Scientific Sessions. Previous studies show that heart rate
problems limit exercise capacity. Some small studies suggest
that constantly controlling heart rate with a pacemaker might
help. ADEPT studied what kind of pacing improves quality of life
(QOL).
	Rate-modulated pacing is when a pacemaker uses sensors
to know when you are physically active, so it can raise its
pacing rate to meet your heart's extra demand for energy during
the activity.
	Automatic mode switching (MS) prevents rapid ventricular
pacing in response to fast atrial beating. However, its effect
on quality of life has not been studied in patients with sinus
node dysfunction instead of atrial-ventricular dysfunction.
	ADEPT studied the effects of dual sensor rate-modulation
(DDDR) and mode switching (MS) pacing. These are options that
can be programmed into many modern pacemakers.

See: http://www.chfpatients.com/glossary.htm#ddd
for explanations of DDD and DDDR.

At one, 3, 6, and 12 month follow-up, patients scored quality of
life (QOL) and symptoms using 3 quality of life questionnaires/
surveys.
	At 12 months, there was no QOL difference between DDD
and DDDR, or between those with MS "on" or MS "off." With a-fib,
there was less lightheadedness in MS "on" patients (9%) than in
MS "off" patients (14%).
	Dr. de Voogt reported no difference in adverse events
for DDD versus DDDR mode with respect to death, nonfatal heart
attack, stroke, CHF hospitalizations, or a-fib. However, MS "off"
did reduce a-fib episodes while MS "on" reduced CHF
hospitalizations.

CONCLUSIONS

This seems to show that DDDR pacing really does not help most
patients in real life. As addressed by Dr. de Voogt, the ADEPT
results, added to the DAVID trial results, show that there is no
reason why "90% of implanted dual-chamber pacemakers are DDDR
units." Current clinical practice may need to be changed.
	Dr. Stephen Hammill added that DDDR pacing is probably
not needed for most patients but will likely be good "in
selected patients."

Sources:   Medscape; NASPE 24th Annual Scientific Sessions Late-
           breaking Clinical Trials I, Advanced Elements of Pacing
           Trial (ADEPT) May 17, 2003; JAMA. 2002;288:3115-3123.