2002Arrhythmias & devicesAtrial fibrillation2010 patients

MOST

Therapy group: Pacing · Therapy: Dual-chamber vs ventricular pacing

In sinus-node dysfunction, dual-chamber pacing did not reduce death or stroke versus ventricular pacing but lowered AF and improved quality of life.

Published in N Engl J Med (2002)

Question: In patients with sinus-node dysfunction needing a pacemaker, does dual-chamber (atrioventricular) pacing improve clinical outcomes compared with ventricular-only pacing?
Design: Randomized trial of 2010 patients assigned to dual-chamber pacing (1014) or ventricular pacing (996), with a median follow-up of 33.1 months.
Population: Patients with sinus-node dysfunction causing clinically significant bradycardia.
Intervention: Pacemaker implantation with dual-chamber (atrioventricular) pacing.
Control: Pacemaker with ventricular-only pacing.
Primary outcome: Composite of death from any cause or nonfatal stroke.
Results: The primary end point did not differ significantly between the dual-chamber group (21.5%) and the ventricular group (23.0%; P=0.48). The dual-chamber group had a lower risk of atrial fibrillation (HR 0.79; 95% CI, 0.66 to 0.94; P=0.008).
Safety: Differences in heart-failure hospitalization and in the composite of death, stroke, or heart-failure hospitalization were not significant in unadjusted analyses and became marginally significant in adjusted analyses.
Conclusion: Dual-chamber pacing did not improve stroke-free survival compared with ventricular pacing, but it reduced atrial fibrillation, improved heart-failure scores, and slightly improved quality of life.
Why it matters: It supported preferring dual-chamber pacing in sinus-node dysfunction because of its benefits on atrial fibrillation, heart-failure symptoms, and quality of life, even without a difference in the primary end point.

Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.

Generated on October 18, 2026

Sources

Original publication on PubMed (PMID 12063369) ↗Ventricular pacing or dual-chamber pacing for sinus-node dysfunction.
Journal article (DOI) ↗

Videos explaining it

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AHA · AHAScience ↗7:13Video page

Source: AHAScience · YouTube
Date: 8 Feb 2024
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