Value of VDD-pacing systems in patients with atrioventricular block: Experience over a decade

Schaer, Beat; Weinbacher, M; Zellweger, Michael J.; Sticherling, Christian; Oßwald, Stefan

doi:10.1016/j.ijcard.2006.11.086

Cited by 22 publications

(19 citation statements)

References 18 publications

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“…Previous studies have demonstrated a gradual decrease in the P wave amplitude during the follow-up period. 15,16 Our study also demonstrated that atrial signal measurements decreased by 60% in the period between implantation and last visit. Many factors may affect the quality and the characteristic of the P wave signals.…”

Section: Discussionsupporting

confidence: 69%

Long‐term Outcome of Atrial Synchronous Mode Pacing in Patients With Atrioventricular Block Using a Single Lead

Blich

Suleiman

Shwiri

et al. 2010

Clinical Cardiology

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Background: Current guidelines suggest the use of atrial synchronous mode (VDD) pacemakers in patients with atrioventricular (AV) block and normal sinus node function. However VDD mode is being used much less than expected. The objectives of our study were to evaluate the efficacy of VDD pacing in long-term follow-up and to find risk factors for VDD loss. Methods: We retrospectively evaluated all patients with VDD pacemakers who were implanted in our center between 1995 and 2007. Results: During the study period, 123 consecutive patients with AV block (51% men, age 62 ± 17.8 years) received a VDD pacemaker. Mean follow up duration was 4.5 ± 3.2 years. At the last follow up visit, 21 patients (21.6%) lost their original VDD mode and were programmed to ventricular-basedpacing (VVIR) (undersensing,11; chronic AF,7; SND,3). In 28 patients, VDD mode was restored or maintained by increasing atrial sensitivity. No episodes of atrial oversensingwere observed. In multivariate analysis history of paroxysmal AF (p = 0.007, odds ratio 36.6, 95% confidence interval 2.7-493.7) and p wave lower than 1 mv during the follow up (p = 0.021, odds ratio 7, 95% confidence interval 1.3-36.7), were found risk factors to VDD loss. Conclusions: VDD pacing has good long-term performance. Absence of paroxysmal AF history predicts maintenance of VDD pacing mode. Taking into account that no atrial oversensing was observed, our recommendation is to increase atrial sensitivity when P wave amplitude declines to less than 1 mv. IntroductionHigh degree atrioventricular (AV) block represents approximately half of permanent pacing indications. Hemodynamic advantages, reduction in the development of atrial fibrillation, and better quality of life are gained by a mode of pacing which preserves AV synchrony compared with ventricular demand pacing.1 -4 Advantages of single lead atrial synchronous mode (VDD) over regular DDD pacing are: it is a less complex implant procedure, and has lower implantation and follow-up costs.5,6 VDD pacing utilizing a single-pass lead with far-field atrial sensing bipoles is a potentially simpler approach to provide the physiological benefits of AV synchronous pacing with a single-lead system. Despite this, VDD pacing is utilized in only 1% to 11%, 1% to 16%, and 2% to 20% of patients receiving pacemakers in America, Asia, and Europe, respectively. 7 This may be related to concern regarding stability of atrial sensing or development of sinus node disease. Most of the previous studies evaluated VDD pacing during a relatively short follow-up. 8 -12 Although some risk factors for losing VDD mode pacing such as old age, low P value, high right-atrial dimension, and atrial dipole placement in low atria were found, 13,14 criteria to optimize atrial sensitivity and VDD pacing have not been completely defined. The aim of our study was to evaluate the efficacy and stability of VDD

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Section: Discussionsupporting

confidence: 69%

Long‐term Outcome of Atrial Synchronous Mode Pacing in Patients With Atrioventricular Block Using a Single Lead

Blich

Suleiman

Shwiri

et al. 2010

Clinical Cardiology

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“…Given these reports, it is curious the fact that the VDD pacemaker is less used than would be expected. Schaer et al [ 10 ] claim that, in clinical practice, VDD pacemaker has an excellent performance in atrioventricular block patients with a presumed normal function of the sinus node, with very low incidence of need for review by loss of atrial sensitivity (2%) and rarely requiring reintervention for DDD pacemaker implant due sinus node dysfunction (1%). According to the authors, the main reason for reprogramming the VDD pacemaker to VVI is the beginning of permanent AF.…”

Section: Discussionmentioning

confidence: 99%

Comparative Study of Electrical Stimulation of the Heart with VDD and DDD Pacemakers as to the Evolution to Atrial Fibrillation

Campos¹,

Andrade²,

Fellicio³

et al. 2017

Braz J Cardiovasc Surg

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IntroductionThe pacemaker implantation VDD is considered simpler, faster, less expensive and causes fewer complications compared to DDD. However, the VDD pacemaker has not been widely used in many centers, perhaps for fear of dysfunction of the sinus node and the reduction of atrial sensitivity by the pacemaker during follow-up after implantation.ObjectiveTo compare patients with DDD and VDD pacemakers regarding the evolution of chronic atrial fibrillation (AF) and length of stay outside this postoperative arrhythmia.MethodsIt was included 158 patients with dual chamber pacemakers, 48 DDD and 110 VDD. Follow-up period: between January 1, 1999 and December 31, 2015. The mean follow-up of patients with DDD was 5.35 years and the VDD, 4.74 years. The percentage of each group (DDD and VDD) which evolved to AF during follow-up was assessed. Also, it was made an actuarial study with the respective curves indicating the time free from AF for each group. Patients were classified according to the diagnosis that led to pacemaker implantation and the degree of heart failure.ResultsThe percentage of patients who developed AF was higher in DDD group (10.42%) than in VDD group (6.36%), but without statistical significance. Patients with DDD and VDD remained free of AF for similar period.ConclusionConsidering the results, the VDD pacemaker continues to be a good option to the DDD for routine use in cases properly indicated.

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“…Thus, they may reduce procedure time and some complications associated with dual-chamber implants. They are used infrequently because the atrial sensing ability of the lead has tended to degrade over time, and implanters are concerned about the potential need for atrial pacing if SND develops (95)(96). However, a VDD pacing system can have a potential role in the management of the younger patient, such as the patient with congenital heart block who might expect multiple system revisions over decades of follow-up (see Recommendations Table 1).…”

Section: Single-lead Dual-chamber Vdd Pacemakersmentioning

confidence: 99%

HRS/ACCF Expert Consensus Statement on Pacemaker Device and Mode Selection

Gillis¹,

Russo²,

Ellenbogen³

et al. 2012

Journal of the American College of Cardiology

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Value of VDD-pacing systems in patients with atrioventricular block: Experience over a decade

Cited by 22 publications

References 18 publications

Long‐term Outcome of Atrial Synchronous Mode Pacing in Patients With Atrioventricular Block Using a Single Lead

Long‐term Outcome of Atrial Synchronous Mode Pacing in Patients With Atrioventricular Block Using a Single Lead

Comparative Study of Electrical Stimulation of the Heart with VDD and DDD Pacemakers as to the Evolution to Atrial Fibrillation

HRS/ACCF Expert Consensus Statement on Pacemaker Device and Mode Selection

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