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Nielsen J.C.,Aarhus University Hospital | Thomsen P.E.B.,Copenhagen University | Hojberg S.,Bispebjerg Hospital | Moller M.,University of Southern Denmark | And 14 more authors.
European Heart Journal | Year: 2011

Aim s In patients with sick sinus syndrome, bradycardia can be treated with a single-lead pacemaker or a dual-chamber pacemaker. Previous trials have revealed that pacing modes preserving atrio-ventricular synchrony are superior to single-lead ventricular pacing, but it remains unclear if there is any difference between single-lead atrial pacing (AAIR) and dual-chamber pacing (DDDR).Methods and resultsWe randomly assigned 1415 patients referred for first pacemaker implantation to AAIR (n 707) or DDDR (n 708) pacing and followed them for a mean of 5.4 ± 2.6 years. The primary outcome was death from any cause. Secondary outcomes included paroxysmal and chronic atrial fibrillation, stroke, heart failure, and need for pacemaker reoperation. In the AAIR group, 209 patients (29.6) died during follow-up vs. 193 patients (27.3) in the DDDR group, hazard ratio (HR) 1.06, 95 confidence interval (CI) 0.881.29, P 0.53. Paroxysmal atrial fibrillation was observed in 201 patients (28.4) in the AAIR group vs. 163 patients (23.0) in the DDDR group, HR 1.27, 95 CI 1.031.56, P 0.024. A total of 240 patients underwent one or more pacemaker reoperations during follow-up, 156 (22.1) in the AAIR group vs. 84 (11.9) in the DDDR group (HR 1.99, 95 CI 1.532.59, P < 0.001). The incidence of chronic atrial fibrillation, stroke, and heart failure did not differ between treatment groups.Conclusion In patients with sick sinus syndrome, there is no statistically significant difference in death from any cause between AAIR pacing and DDDR pacing. AAIR pacing is associated with a higher incidence of paroxysmal atrial fibrillation and a two-fold increased risk of pacemaker reoperation. These findings support the routine use of DDDR pacing in these patients. Clinical Trial Registration: URL http://www.clinicaltrials.gov. Unique identifier: NCT00236158. © 2010 The Author. Source

Nielsen J.C.,Aarhus University Hospital | Thomsen P.E.B.,Copenhagen University | Hojberg S.,Bispebjerg Hospital | Moller M.,University of Southern Denmark | And 14 more authors.
Europace | Year: 2012

Aims: In the recently published DANPACE trial, incidence of atrial fibrillation (AF) was significantly higher with single-lead atrial (AAIR) pacing than with dual-chamber (DDDR) pacing. The present analysis aimed to evaluate the importance of baseline PQ-interval and percentage of ventricular pacing (VP) on AF. Methods and results: We analysed data on AF during follow-up in 1415 patients included in the DANPACE trial. In a subgroup of 650 patients with DDDR pacemaker, we studied whether VP, baseline PQ-interval, and programmed atrio-ventricular interval (AVI) was associated with AF burden measured as time in mode-switch (MS) detected by the pacemaker. In the entire DANPACE study population, the incidence of AF was significantly higher in patients with baseline PQ-interval >180 ms (P< 0.001). Among 650 patients with DDDR pacemaker, telemetry data were available for 1.337 ± 786 days, %VP was 66 ± 33%, AF was detected at planned follow-up in 160 patients (24.6%), MS occurred in 422 patients (64.9%), and AF burden was marginally higher with baseline PQ-interval >180 ms (P = 0.028). No significant association was detected between %VP and %MS (Spearmans ρ 0.056, P = 0.154). %MS was not different between minimal-paced programmed AVI ≤ 100 and >100 ms (median value), respectively (P = 0.60). Conclusions: The present study indicates that a longer baseline PQ-interval is associated with an increased risk of AF in patients with sick sinus syndrome. Atrial fibrillation burden is not associated with the percentage of VP or the length of the programmed AVI. © 2011 The Author. Source

Preiss B.S.,University of Southern Denmark | Bergman O.J.,University of Southern Denmark | Friis L.S.,University of Southern Denmark | Sorensen A.G.,University of Southern Denmark | And 5 more authors.
Cancer Genetics and Cytogenetics | Year: 2010

During a 15-year period, 161 adult patients were diagnosed with secondary acute myeloid leukemia (s-AML) in the region of Southern Denmark. In 73 patients, the AML diagnosis was preceded by myelodysplastic syndrome (MDS-AML), in 31 patients by an antecedent hematologic disease, and in 57 patients by treatment with chemotherapy and/or irradiation (t-AML). Cytogenetic analysis was carried out in 93%, of which 61% had clonal chromosome aberrations. MDS-AML correlated to a normal karyotype (P < 0.001). t-AML correlated to abnormal clones with numerical and structural aberrations (P = 0.03), five or more unrelated aberrations (P = 0.03), marker chromosomes (P = 0.006), abnormal mitoses only (P = 0.01), female sex (P < 0.001), and -7 (P = 0.006). Centromeric breakage correlated to a complex karyotype (P = 0.01). The frequencies of aberrations in s-AML patients were compared with an age-matched group of de novo AML patients diagnosed in the same area and period. In this comparison, s-AML only correlated to -7 (P = 0.02). In 42 patients, we found that MDS patients with an abnormal karyotype were more likely to show cytogenetic evolution during progression to AML than MDS patients with a normal karyotype (P = 0.01). We conclude that population-based cytogenetic studies of adult s-AML and age- and sex-matched de novo AML show comparable distributions of chromosome abnormalities. © 2010 Elsevier Inc. Source

Riahi S.,University of Aalborg | Nielsen J.C.,Aarhus University Hospital | Hjortshoj S.,University of Aalborg | Thomsen P.E.B.,Copenhagen University | And 14 more authors.
Europace | Year: 2012

AimsPrevious studies indicate that ventricular pacing may precipitate heart failure (HF). We investigated occurrence of HF during long-term follow-up among patients with sick sinus syndrome (SSS) randomized to AAIR or DDDR pacing. Furthermore, we investigated effects of percentage of ventricular pacing (VP) and pacing site in the ventricle.Methods and resultsWe analysed data from 1415 patients randomized to AAIR (n 707) or DDDR pacing (n 708). Ventricular pacing leads were recorded as located in either an apical or a non-apical position. The VP and HF hospitalizations were recorded during follow-up. Patients were classified with new HF, if in New York Heart Association (NYHA) functional class IV or if presence of <2 of: oedema; dyspnoea; NYHA functional class III. Mean follow-up was 5.4 ± 2.4 years. Heart failure hospitalizations did not differ between groups. In the AAIR group, 170 of the 707 (26) patients developed HF vs. 169 of the 708 (26) patients in the DDDR group, hazard rate ratio (HR) 1.00, 95 confidence interval (CI) 0.791.22, P 0.87. In DDDR patients, 146 of the 512 patients (29) with ventricular leads in an apical position developed HF vs. 28 of the 161 patients (17) with the leads in a non-apical position, HR 0.67, CI 0.451.00, P 0.05. After adjustments this difference was non-significant. The incidence of HF was not associated with VP (P 0.57).ConclusionIn patients with SSS, HF was not associated with pacing mode, VP, or ventricular lead localization. This suggests that DDDR pacing is safe in patients with SSS without precipitating HF. © The Author 2012. Source

Kristensen L.,University of Southern Denmark | Kristensen T.,University of Southern Denmark | Abildgaard N.,University of Southern Denmark | Thomassen M.,University of Southern Denmark | And 3 more authors.
Leukemia Research | Year: 2015

Chronic lymphocytic leukemia (CLL) is the most common leukemia among adults in the Western world. Autophagy is a highly conserved process in eukaryotic cells. In CLL autophagy is involved in mediating the effect of chemotherapy but the role of autophagy in CLL pathogenesis remains unknown.In the present study, we used real-time RT-PCR to analyze expression of the PIK3C3, PIK3R4, and BECN1 genes. These genes encode the components of the PI3K core complex, which is central to initiation of autophagy. A consecutive series of 149 well-characterized CLL cases from Region of Southern Denmark were included in the study. All three genes were observed to be independent markers of prognosis in CLL with high expression being associated with more aggressive disease. With this clear association with outcome in CLL, these genes thereby represent promising candidates for future functional studies on the role of autophagy in CLL, and they may further represent targets of treatment. © 2015 Elsevier Ltd. Source

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