The Mode Selection Trial (MOST) was supported by grants U01 HL 49804 and U01 HL 53973 from the National Heart, Lung, and Blood Institute of the National Institutes of Health. Medtronic, Inc., Guidant Corporation, and St. Jude Medical donated additional support for study meetings and ancillary studies.
Reduced Ejection Fraction, Sudden Cardiac Death, and Heart Failure Death in the Mode Selection Trial (MOST): Implications for Device Selection in Elderly Patients with Sinus Node Disease
Article first published online: 28 JUN 2008
© 2008 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 19, Issue 11, pages 1160–1166, November 2008
How to Cite
SWEENEY, M. O., HELLKAMP, A. S., ELLENBOGEN, K. A. and LAMAS, G. A. (2008), Reduced Ejection Fraction, Sudden Cardiac Death, and Heart Failure Death in the Mode Selection Trial (MOST): Implications for Device Selection in Elderly Patients with Sinus Node Disease. Journal of Cardiovascular Electrophysiology, 19: 1160–1166. doi: 10.1111/j.1540-8167.2008.01209.x
Dr. Sweeney has received grant support and other research support from, is a paid consultant to, has served on the speakers' bureau of, and has received honoria from Medtronic; he has received honoria for speaking from Boston Scientific Corporation and St. Jude Medical. Dr. Ellenbogen has received honoria for speaking from Medtronic, Boston Scientific Corporation, and St. Jude Medical. Dr. Lamas is a consultant on research grants from Medtronic and Astellas.
Manuscript received 9 February 2008; Revised manuscript received 26 March 2008; Accepted for publication 28 March 2008.
- Issue published online: 5 NOV 2008
- Article first published online: 28 JUN 2008
- sudden death;
- heart failure
Background: The purpose of this study was to describe the incidence and predictors of sudden cardiac death (SCD) and heart failure (HF) death, and coexisting indications for ICDs and CRT, in patients with sinus node disease (SND) treated with pacemakers.
Methods and Results: Baseline variables were used to predict SCD and HF death among 1,135 patients in the Mode Selection Trial, a 6-year trial of pacing mode in SND. There were 73 deaths among 177 patients with EF ≤ 35% (41.2%), 46/156 (29.5%) with EF 36–49%, and 147/802(18.3%) with EF ≥ 50%. SCD accounted for 21.9%, 23.9%, and 14.3% of deaths with EF ≤ 35%, 36–49%, and ≥ 50%. HF deaths accounted for 23.3%, 19.6%, and 3.4% of deaths with EF ≤ 35%, 36-49%, and ≥ 50%. EF ≤ 35% predicted SCD (hazard ratio [HR] 3.68, 95% confidence interval [CI] 1.72-7.89, P = 0.002) and HF death (HR 10.17, 95% CI 3.35, 30.82, P = 0.001). Four-year SCD rate with EF ≤ 35% was 15.5% (3.9% annually).
Nearly one-fifth of patients qualified for ICDs (EF ≤ 35%) and half of these had QRS ≥ 120 ms. However, >40% died within 33 months (4-year noncardiac death rate ∼22%).
Conclusions: Reduced EF predicts SCD and HF death in SND treated with pacemakers. SCD rates among patients with EF ≤ 35% are similar to control arms of primary prevention ICD trials, but mortality rates are significantly higher. Whether ICDs or CRT to provide bradycardia support would prolong life in elderly patients with EF ≤ 35% and SND merits prospective investigation.