In Reply: Drs Groh and Bhakta raise several methodological issues regarding our study.1 We found that an invasive strategy based on electrophysiological study followed by prophylactic pacing when necessary was associated with a longer mean survival compared with a noninvasive strategy, reserving the implantation of permanent pacemakers for patients presenting with high-degree atrioventricular block. Ever since prophylactic pacing in DM1 was assigned a class IIb indication in the American College of Cardiology/American Heart Association practice guidelines,2 both strategies have been used equally in clinical practice and, in our study, the assignment of patients to a strategy was left to the judgment of the cardiologist in charge of the patient. We found that the most gravely ill patients were more likely to undergo invasive management, which tended to diminish the benefit conferred by this strategy. Of 914 patients, we excluded 4 from the analysis who underwent prophylactic pacing without prior electrophysiological study. This small number of patients is not surprising, given the low power of the electrocardiogram to predict sudden death. Reclassifying these patients to the noninvasive group had no influence on the 75% lower hazard of dying suddenly.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 1
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.