biostudies-literatureUnknown26(7)Pisano ECLBiotronik SE &amp; Co KGBiotronik SE & Co KG<h4>Aims</h4>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.<h4>Methods and results</h4>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 ≥6 min, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiologyeuae175https://www.ebi.ac.uk/biostudies/studies/S-EPMC11226787biostudies-literatureClosed loop stimulation reduces the incidence of atrial high-rate episodes compared with conventional rate-adaptive pacing in patients with sinus node dysfunctions.PMC11226787Coppolino AMerkely BMenichelli MChing CKBotto GLCarretta DMArena GPelargonio GGargaro ASaporito DDel Maestro MLazzari LSu XRapacciuolo ADel Castillo AMCalvi VNicosia ABertaglia EViscusi MCaccavo VLin LYGiacopelli DWang CCBontempi LOh IYPisano ECLfalseClosed loop stimulation reduces the incidence of atrial high-rate episodes compared with conventional rate-adaptive pacing in patients with sinus node dysfunctions.<h4>Aims</h4>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.<h4>Methods and results</h4>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 ≥6 min, 2024-01-01T00:00:00Z2024 Jul2026-06-02T22:49:20.611Z2025-04-04T12:21:57.031ZS-EPMC112267873893816910.1093/europace/euae175