Long-term outcome in patients receiving permanent pacemaker implantation for atrioventricular block

Abstract

A permanent pacemaker (PPM) with dual chamber pacing (DDD) offers atrioventricular synchronization for patients with atrioventricular block (AVB). Single lead atrial synchronous ventricular pacing mode (VDD) is an alternative, but there are concerns about its efficacy and risk of atrial undersensing. Whether VDD can be a good alternative in patients with AVB remains unknown. The aim of the present study was to compare the long-term risk of mortality of VDD with DDD pacing.A total of 207 patients undergoing PPM implantations for AVB with VDD mode were enrolled from 2000 to 2013. Another 828 age- and sex-matched patients undergoing DDD implantations during the same period of time were selected as the control group in a 1 to 4 ratio. The study endpoint was mortality.A total of 1035 patients (64.3% male) were followed up for 46.5 ± 43.2 months. The mean ages were 75.0 years for VDD, and 74.9 years for DDD. The Kaplan–Meier survival analysis showed no significant difference in long-term survival between the VDD and DDD groups (log-rank P = 0.313). After adjustment for baseline characteristics, the VDD and DDD groups had a similar long-term prognosis with an adjusted hazard ratio of 0.875 (P = 0.445). Further analyses for the risk of cardiovascular and noncardiovascular deaths also showed no significant differences between the 2 groups.The long-term prognosis of VDD mode is comparable to that of DDD mode. Single lead VDD can be considered as an alternative choice in patients with AVB without sinus nodal dysfunction.

Association of selected factors with long-term prognosis and mortality after dual-chamber pacemaker implant

“…Regarding baseline characteristics, a higher prevalence of men across the study period was observed, which is in accordance with the majority of studies in DDD PM populations [15][16][17]19] and general PM populations [1,2,5,9,12,13,18] except for Scandinavian populations, in which the prevalence of women receiving first DDD PM was reported to be higher than that of men [20,21]. In the present study, the prevalence of men exhibited a statistically significant decreasing trend from 58% in the first decade to 52% in the third decade, which is opposed to observations of a stable proportion of men in successive eras of PM implantation [1,2].…”

“…The 1-year survival rate of the present DDD cohort was 96%. These data appear to accord with 1-year overall survival rates from 90.5% to 96% as provided in reports of DDD populations [4,12,15,16] and rates from 91% to 94% as provided in reports of general PM populations [1,5,13,14]. At 5-year follow-up, cumulative survival rate was 82%.…”

Predictors of outcomes in hospitalized patients undergoing pacemaker insertion: Analysis from the national inpatient database (2016‐2017)

“…Both heart failure and history of malignancy are well established poor prognostic indicators for mortality after pacemaker placement 9,14 . Heart failure has been estimated to reduce the patient's post‐pacemaker implantation life expectancy by 3.5 years 15 .…”

Cardiac Stimulation in the Third Millennium: Where Do We Head from Here?

“…This is the typical scenario for paroxysmal/persistent AVB and CRT, where RAA placement enables reliable atrial sensing. Single lead VDD pacemakers were developed to minimize lead-related complications when atrial stimulation is redundant [17,18].…”