1
|
Mei DA, Imberti JF, Vitolo M, Bonini N, Gerra L, Romiti GF, Proietti M, Lip GYH, Boriani G. Single-lead VDD pacing: a literature review on short-term and long-term performance. Expert Rev Med Devices 2023; 20:187-197. [PMID: 36755414 DOI: 10.1080/17434440.2023.2178901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
INTRODUCTION VDD pacing system was introduced more than 30 years ago. Its use is considered by the 2021 European Society of Cardiology guidelines on cardiac pacing as a potential alternative to dual chambers system for patients with atrioventricular block and normal sinus node function. AREAS COVERED In this article, we performed a narrative review of current literature in order to identify the strengths and weaknesses of this pacing system. VDD system allows the maintenance of AV synchronous pacing and its hemodynamic advantages. Some disadvantages may be related to the non-negligible incidence of atrial undersensing and the possible subsequent need for upgrade to DDD system. On the other hand, shorter implantation time and lower complications rate may be advantages. EXPERT OPINION In the modern pacing era, VDD pacing system struggles to find its own space. However, it may still be considered as a valuable alternative to a dual-chamber pacemaker for selected patients, in specific clinical scenarios.
Collapse
Affiliation(s)
- Davide Antonio Mei
- Cardiology Division Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Jacopo Francesco Imberti
- Cardiology Division Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Vitolo
- Cardiology Division Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Niccolò Bonini
- Cardiology Division Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Luigi Gerra
- Cardiology Division Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulio Francesco Romiti
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Translational and Precision Medicine, Sapienza - University of Rome, Rome, Italy
| | - Marco Proietti
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Giuseppe Boriani
- Cardiology Division Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
2
|
Sanna GD, Nusdeo G, Marini A, Ganga ML, Mura E, Pisano M, Sabino G, Parodi G. Outcomes of single‑lead VDD pacemakers in atrioventricular blocks: The OSCAR study. Int J Cardiol 2020; 325:62-68. [PMID: 32987050 DOI: 10.1016/j.ijcard.2020.09.063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/17/2020] [Accepted: 09/22/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND VDD pacemakers are regarded as a second choice in patients with atrio-ventricular blocks mainly due to the potential failure of atrial sensing, leading to a loss of atrio-ventricular synchrony. This single-centre study aimed to evaluate the prevalence of loss of atrial sensing and its potential determinants in patients with VDD pacemakers. METHOD 142 patients with an implanted VDD device underwent long-term follow-up with clinical evaluation, electrocardiogram, device interrogation and echocardiogram. RESULTS Over a long follow-up period [median 110 (68-156) months], 17 patients (12%) in sinus rhythm presented loss of atrial sensing. This was most often intermittent, but three patients required a permanent switch to VVI mode. ECG showed higher prevalence of interatrial blocks (50% vs 26.6%, p = 0.057) and longer P wave duration (116 ± 19 vs 105 ± 15 ms, p = 0.019) in patients with loss of atrial sensing. Echocardiography revealed larger left atrial (LA) volumes (p < 0.05) in patients with loss of atrial sensing, and lower LA ejection fraction (0.40 vs 0.47, p = 0.0037) and expansion index (0.63 ± 0.26 vs 0.90 ± 0.31, p = 0.003). P wave duration on ECG proved to be independently associated with loss of atrial sensing on multivariable analysis (OR 1.062, 95% CI 1.015-1.110; p = 0.008). The prevalence of atrial fibrillation and subsequent switch to VVI mode was high (16%). CONCLUSIONS In the long-term follow-up, the loss of atrial sensing is present in 12% of patients with implanted VDD pacemakers. ECG and echocardiographic parameters may serve as screening tools for the detection of atrial myopathy which is associated with the loss of atrial sensing.
Collapse
Affiliation(s)
- Giuseppe D Sanna
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy.
| | - Giuseppe Nusdeo
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy.
| | - Alessandro Marini
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
| | - Maria Luisa Ganga
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
| | - Enrico Mura
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
| | - Mauro Pisano
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
| | - Giuseppe Sabino
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
| | - Guido Parodi
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy.
| |
Collapse
|
3
|
Povero M, Miceli A, Pradelli L, Ferrarini M, Pinciroli M, Glauber M. Cost-utility of surgical sutureless bioprostheses vs TAVI in aortic valve replacement for patients at intermediate and high surgical risk. CLINICOECONOMICS AND OUTCOMES RESEARCH 2018; 10:733-745. [PMID: 30510436 PMCID: PMC6231515 DOI: 10.2147/ceor.s185743] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Meta-analyses of studies comparing transcatheter aortic valve implants (TAVIs) and sutureless aortic valve replacement (SU-AVR) show differing effectiveness and safety profiles. The approaches also differ in their surgical cost (including operating room and device). OBJECTIVE The objective of this study was to assess the incremental cost-utility of SU-AVR vs TAVIs for the treatment of intermediate- to high-risk patients in the US, Germany, France, Italy, UK, and Australia. METHODS A patient-level simulation compares in-hospital pathways of patients undergoing SU-AVR or TAVIs; later, patient history is modeled at the cohort level. Hospital outcomes for TAVIs reproduce data from recent series; in SU-AVR patients, outcomes are obtained by applying relative efficacy estimates in a recent meta-analysis on 1,462 patients. After discharge, survival depends on the development of paravalvular leak and the need for dialysis. A comprehensive third-party payer perspective encompassing both in-hospital and long-term costs was adopted. RESULTS Due to lower in-hospital (4.1% vs 7.0%) and overall mortality, patients treated with SU-AVR are expected to live an average of 1.25 years more compared with those undergoing TAVIs, with a mean gain of 1.14 quality-adjusted life-years. Both in-hospital and long-term costs were lower for SU-AVR than for TAVIs with total savings ranging from $4,158 (France) to $20,930 (US). CONCLUSION SU-AVR results dominant when compared to TAVIs in intermediate- to high-risk patients. Both in-hospital and long-term costs are lower for SU-AVR than for TAVI patients, with concomitant significant gains in life expectancy, both raw and adjusted for the quality of life.
Collapse
Affiliation(s)
| | - Antonio Miceli
- Minimally Invasive Cardiothoracic Department, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | | | - Matteo Ferrarini
- Minimally Invasive Cardiothoracic Department, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | | | - Mattia Glauber
- Minimally Invasive Cardiothoracic Department, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| |
Collapse
|
4
|
Kurt M, Jathanna N, Babady M, Schmidt J, Müller P, Gerguri S, Clasen L, Bejinariu A, Kelm M, Fürnkranz A, Makimoto H. Avoiding inappropriate therapy of single-lead implantable cardioverter-defibrillator by using atrial-sensing electrodes. J Cardiovasc Electrophysiol 2018; 29:1682-1689. [PMID: 30203568 DOI: 10.1111/jce.13736] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 08/22/2018] [Accepted: 08/27/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The single-chamber implantable cardioverter-defibrillator (ICD) can be associated with more frequent inappropriate therapies compared with dual-chamber ICDs, when they are accompanied by a simpler implantation procedure. The aim of this study was to investigate whether the use of a single-lead ICD system with atrial-sensing electrodes results in a reduction of inappropriate ICD therapy. METHODS AND RESULTS The study population consisted of 212 consecutive patients, who underwent primary prophylactic single-lead ICD implantation at our institute. A ventricular lead with atrial-sensing electrodes was implanted in 77 patients (36%; Group-VDD) and a ventricular lead without atrial-sensing electrodes was implanted in 135 patients (64%; Group-VVI). Procedural and follow-up data were collected in a prospective registry. A higher prevalence of atrial fibrillation was present in Group-VDD. There were no other significant differences in patient baseline characteristics (age, sex, and other comorbidities) or follow-up period between the two groups. The operative parameters including fluoroscopic burden showed no significant differences between Group-VDD and Group-VVI. During a mean follow-up period of 697 ± 392 days, 26 patients (12%) experienced appropriate ICD therapies and 13 patients (6%) suffered inappropriate ICD therapies. The incidence of inappropriate ICD therapies in Group-VDD was significantly lower as compared to that of Group-VVI (1/77 [1%] vs 12/135 [9%]; log-rank, P = 0.028). The incidence of appropriate ICD therapies and the occurrence of device-related complications showed no significant difference between the two groups. CONCLUSION Single-lead ICD with atrial-sensing electrodes shows a lower incidence of inappropriate ICD therapy compared with the absence of atrial-sensing electrodes, without additional operative burden or increased complications.
Collapse
Affiliation(s)
- Muhammed Kurt
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Nikesh Jathanna
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Mehran Babady
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Jan Schmidt
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Patrick Müller
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Shqipe Gerguri
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Lukas Clasen
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Alexandru Bejinariu
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Cardiovascular Research Institute Duesseldorf (CARID), Medical Faculty of the Heinrich Heine University Düsseldorf, Duesseldorf, Germany
| | - Alexander Fürnkranz
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Cardiovascular Research Institute Duesseldorf (CARID), Medical Faculty of the Heinrich Heine University Düsseldorf, Duesseldorf, Germany
| | - Hisaki Makimoto
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Cardiovascular Research Institute Duesseldorf (CARID), Medical Faculty of the Heinrich Heine University Düsseldorf, Duesseldorf, Germany
| |
Collapse
|
5
|
Chan WK, Danon A, Wijeysundera HC, Singh SM. Single Versus Dual Lead Atrioventricular Sequential Pacing for Acquired Atrioventricular Block During Transcatheter Aortic Valve Implantation Procedures. Am J Cardiol 2018; 122:633-637. [PMID: 30205889 DOI: 10.1016/j.amjcard.2018.04.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 04/23/2018] [Accepted: 04/23/2018] [Indexed: 11/25/2022]
Abstract
Atrioventricular block (AVB) after transcatheter aortic valve implantation (TAVI) is common. Pacing platforms that preserve atrioventricular (AV) synchrony may be beneficial in these patients. Single lead AV sequential pacemakers (VDD) allow AV synchrony and, by virtue of implanting a single lead, can be advantageous when compared with traditional dual lead (DDD) pacemakers. The objective of this retrospective case-controlled study was to compare the strategy of AV sequential pacing with a VDD versus DDD pacemaker in consecutive TAVI patients (n = 120) with acquired AVB. Patients were classified as receiving a VDD (n = 73) or DDD (n = 47) pacemaker. Procedure characteristics, complications, and the need for long-term ventricular pacing reported. Pacemaker implantation time (51 vs 66 minutes and p <0.001), fluoroscopy time (3.7 vs 7.8 minutes and p = 0.004), and radiation exposure (dose area product: 6.5 vs 15.3 mGy/cm2 and p = 0.006) were lower in patients receiving VDD pacemakers. Procedural complications were similar in the 2 groups. Overall, 59% of the cohort required ≥50% ventricular pacing at 1-year follow-up. In conclusion, VDD pacemaker implantation was associated with shorter procedure times, lower radiation exposure, and similar safety outcomes when compared with DDD pacemaker implantation in TAVI patients with acquired AVB.
Collapse
|
6
|
Campos NLKLD, Andrade RRD, Fellicio ML, Martins AS, Garzesi AM, Garcia LR, Takeda TB. Comparative Study of Electrical Stimulation of the Heart with VDD and DDD Pacemakers as to the Evolution to Atrial Fibrillation. Braz J Cardiovasc Surg 2017; 32:347-353. [PMID: 29211212 PMCID: PMC5701096 DOI: 10.21470/1678-9741-2017-0505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 04/10/2017] [Indexed: 11/09/2022] Open
Abstract
Introduction The 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. Objective To compare patients with DDD and VDD pacemakers regarding the evolution of
chronic atrial fibrillation (AF) and length of stay outside this
postoperative arrhythmia. Methods It 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. Results The 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. Conclusion Considering the results, the VDD pacemaker continues to be a good option to
the DDD for routine use in cases properly indicated.
Collapse
|
7
|
Liao JN, Chao TF, Tuan TC, Kong CW, Chen SA. Long-term outcome in patients receiving permanent pacemaker implantation for atrioventricular block: Comparison of VDD and DDD pacing. Medicine (Baltimore) 2016; 95:e4668. [PMID: 27583889 PMCID: PMC5008573 DOI: 10.1097/md.0000000000004668] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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.
Collapse
Affiliation(s)
- Jo-Nan Liao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University
| | - Ta-Chuan Tuan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University
- Division of Cardiology, Taipei Municipal Gan-Dau Hospital
- Correspondence: Ta-Chuan Tuan, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan (e-mail: )
| | - Chi-Woon Kong
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University
- Division of Cardiology, Department of Medicine, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University
| |
Collapse
|
8
|
Edwards SJ, Karner C, Trevor N, Wakefield V, Salih F. Dual-chamber pacemakers for treating symptomatic bradycardia due to sick sinus syndrome without atrioventricular block: a systematic review and economic evaluation. Health Technol Assess 2016; 19:1-210. [PMID: 26293406 DOI: 10.3310/hta19650] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Bradycardia [resting heart rate below 60 beats per minute (b.p.m.)] can be caused by conditions affecting the natural pacemakers of the heart, such as sick sinus syndrome (SSS) and atrioventricular (AV) blocks. People suffering from bradycardia may present with palpitations, exercise intolerance and fainting. The only effective treatment for patients suffering from symptomatic bradycardia is implantation of a permanent pacemaker. OBJECTIVE To appraise the clinical effectiveness and cost-effectiveness of dual-chamber pacemakers compared with single-chamber atrial pacemakers for treating symptomatic bradycardia in people with SSS and no evidence of AV block. DATA SOURCES All databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Health Technology Assessment database, NHS Economic Evaluations Database) were searched from inception to June 2014. METHODS A systematic review of the clinical and economic literature was carried out in accordance with the general principles published by the Centre for Reviews and Dissemination. Randomised controlled trials (RCTs) evaluating dual-chamber and single-chamber atrial pacemakers and economic evaluations were included. Pairwise meta-analysis was carried out. A de novo economic model was developed. RESULTS Of 493 references, six RCTs were included in the review. The results were predominantly influenced by the largest trial DANPACE. Dual-chamber pacing was associated with a statistically significant reduction in reoperation [odds ratio (OR) 0.48, 95% confidence interval (CI) 0.36 to 0.63] compared with single-chamber atrial pacing. The difference is primarily because of the development of AV block requiring upgrade to a dual-chamber device. The risk of paroxysmal atrial fibrillation was also reduced with dual-chamber pacing compared with single-chamber atrial pacing (OR 0.75, 95% CI 0.59 to 0.96). No statistically significant difference was found between the pacing modes for mortality, heart failure, stroke, chronic atrial fibrillation or quality of life. However, the risk of developing heart failure may vary with age and device. The de novo economic model shows that dual-chamber pacemakers are more expensive and more effective than single-chamber atrial devices, resulting in a base-case incremental cost-effectiveness ratio (ICER) of £6506. The ICER remains below £20,000 in probabilistic sensitivity analysis, structural sensitivity analysis and most scenario analyses and one-way sensitivity analyses. The risk of heart failure may have an impact on the decision to use dual-chamber or single-chamber atrial pacemakers. Results from an analysis based on age (> 75 years or ≤ 75 years) and risk of heart failure indicate that dual-chamber pacemakers dominate single-chamber atrial pacemakers (i.e. are less expensive and more effective) in older patients, whereas dual-chamber pacemakers are dominated by (i.e. more expensive and less effective) single-chamber atrial pacemakers in younger patients. However, these results are based on a subgroup analysis and should be treated with caution. CONCLUSIONS In patients with SSS without evidence of impaired AV conduction, dual-chamber pacemakers appear to be cost-effective compared with single-chamber atrial pacemakers. The risk of developing a complete AV block and the lack of tools to identify patients at high risk of developing the condition argue for the implantation of a dual-chamber pacemaker programmed to minimise unnecessary ventricular pacing. However, considerations have to be made around the risk of developing heart failure, which may depend on age and device. STUDY REGISTRATION This study is registered as PROSPERO CRD42013006708. FUNDING The National Institute for Health Research Health Technology Assessment programme.
Collapse
|
9
|
Lichtenberger J, Scollan KF, Bulmer BJ, Sisson DD. Long-term outcome of physiologic VDD pacing versus non-physiologic VVI pacing in dogs with high-grade atrioventricular block. J Vet Cardiol 2015; 17:42-53. [DOI: 10.1016/j.jvc.2014.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 12/17/2014] [Accepted: 12/23/2014] [Indexed: 10/24/2022]
|
10
|
Shurrab M, Elitzur Y, Healey JS, Gula L, Kaoutskaia A, Israel C, Lau C, Crystal E. VDD vs DDD Pacemakers: A Meta-analysis. Can J Cardiol 2014; 30:1385-91. [DOI: 10.1016/j.cjca.2014.04.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 04/25/2014] [Accepted: 04/26/2014] [Indexed: 11/30/2022] Open
|
11
|
Krychtiuk KA, Nürnberg M, Volker R, Pachinger L, Jarai R, Freynhofer MK, Wojta J, Huber K, Weiss TW. Effects of AV-delay optimization on hemodynamic parameters in patients with VDD pacemakers. Wien Klin Wochenschr 2014; 126:270-7. [PMID: 24652015 DOI: 10.1007/s00508-014-0520-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 02/04/2014] [Indexed: 02/05/2023]
Abstract
AIM Atrioventricular (AV) delay optimization improves hemodynamics and clinical parameters in patients treated with cardiac resynchronization therapy and dual-chamber-pacemakers (PM). However, data on optimizing AV delay in patients treated with VDD-PMs are scarce. We, therefore, investigated the acute and chronic effects of AV delay optimization on hemodynamics in patients treated with VDD-PMs due to AV-conduction disturbances. METHODS In this prospective, single-center interventional trial, we included 64 patients (38 men, 26 women, median age: 77 (70-82) years) with implanted VDD-PM. AV-delay optimization was performed using a formula based on the surface electrocardiogram (ECG). Hemodynamic parameters (stroke volume (SV), cardiac output (CO), heart rate (HR), and blood pressure (BP)) were measured at baseline and follow-up after 3 months using impedance cardiography. RESULTS Using an ECG formula for AV-delay optimization, the AV interval was decreased from 180 (180-180) to 75 (75-100) ms. At baseline, AV-delay optimization led to a significant increase of both SV (71.3 ± 15.8 vs. 55.3 ± 12.7 ml, p < 0.001, for optimized AV delay vs. nominal AV interval, respectively) and CO (5.1 ± 1.4 vs. 3.9 ± 1.0 l/min, p < 0.001), while HR and BP remained unchanged. At follow-up, the improvement in CO remained stable (4.9 ± 1.3 l/min, p = 0.09), while SV slightly, but significantly, decreased (to 65.1 ± 17.6, p < 0.01). CONCLUSION AV-delay optimization in patients treated with VDD-PMs exhibits immediate beneficial effects on hemodynamic parameters that are sustained for 3 months.
Collapse
Affiliation(s)
- Konstantin A Krychtiuk
- Department of Internal Medicine II-Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria,
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Chen S, Yin Y, Lan X, Liu Z, Ling Z, Su L, Kiuchi MG, Li X, Zhong B, Krucoff MW. Paced QRS duration as a predictor for clinical heart failure events during right ventricular apical pacing in patients with idiopathic complete atrioventricular block: results from an observational cohort study (PREDICT-HF). Eur J Heart Fail 2012; 15:352-9. [PMID: 23275473 DOI: 10.1093/eurjhf/hfs199] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS The aim of this study was to investigate the predictive ability of paced QRS duration (pQRSd) for heart failure events among patients receiving right ventricular apical pacing (RVAP). METHODS AND RESULTS A total of 194 patients with complete atrioventricular block receiving pacemaker treatment were enrolled and stratified to group 1, pQRSd < 160 ms, n = 53; group 2, 160 ≤ pQRSd < 190 ms, n = 97; and group 3, pQRSd ≥ 190 ms, n = 44. Study outcomes were heart failure events, changes in pQRSd, and changes in left ventricular ejection fraction (LVEF). During the 3-year follow-up, the incidence of heart failure events was 9.4, 27.8, and 56.8% in groups 1, 2, and 3, respectively (P < 0.001). Among the patients without heart failure events, the pQRSd at 3 years remained longer than that at baseline (162.1 ± 22.6 vs. 160.9 ± 22.1 ms, P < 0.05), whereas among patients who experienced heart failure events, the prolonged pQRSd at 3 years seemed more pronounced as compared with baseline (184.1 ± 21.1 vs. 179.8 ± 21 ms, P < 0.001). Linear regression demonstrated that a decrease in LVEF was positively correlated with pQRSd over time (relative risk 0.423; P < 0.05). The receiver operating charactersitic curve showed that the cut-off value of pQRSd was 165 ms with a sensitivity of 0.789. CONCLUSION A prolonged pQRSd has a detrimental effect on long-term cardiac function during RVAP in patients with complete atrioventricular block. pQRSd could be a useful predictor to identify patients who are at risk for heart failure events during RVAP.
Collapse
Affiliation(s)
- Shaojie Chen
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Wiegand UKH. Single-lead VDD pacing--a serious alternative for atrioventricular synchronous pacing in patients with atrioventricular block? Europace 2011; 14:461-2. [DOI: 10.1093/europace/eur408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
14
|
Marchandise S, Scavee C, le Polain de Waroux JB, de Meester C, Vanoverschelde JL, Debbas N. Long-term follow-up of DDD and VDD pacing: a prospective non-randomized single-centre comparison of patients with symptomatic atrioventricular block. Europace 2011; 14:496-501. [DOI: 10.1093/europace/eur345] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
15
|
Modi S, Krahn A, Yee R. Current concepts in pacing 2010-2011: the right and wrong way to pace. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2011; 13:370-84. [PMID: 21710197 DOI: 10.1007/s11936-011-0137-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OPINION STATEMENT Over five decades have passed since the first permanent cardiac pacemakers were introduced into clinical medicine. Evolving technology and falling costs have demanded adaptation to clinical practice and implantation trends and, with the advent of evidenced-based medicine, the specific roles and benefits of individual pacemaker technologies have never been so carefully scrutinized. Pacing mode choice continues to be a subject of great controversy, and there are great regional variations in practice. We believe that single chamber atrial pacing use (AAI/R) has become an anachronism that should generally be abandoned (obviously with rare exceptional cases) and be replaced by dual chamber pacemakers (DDD/R) equipped with modern pacing algorithms that minimize patient exposure to ventricular pacing. Also, in patients with atrioventricular (AV) block, randomized clinical trials have failed to show improvement in clinically relevant outcomes such as mortality, stroke, and heart failure, particularly in the elderly, which has led some to advocate that DDD/R devices should never be offered to elderly AV block patients. However, we believe that the elderly, like the young, come in many "shapes and sizes" and individualized medicine compels us to consider each pacemaker candidate as unique. Implanting DDD/R devices in chronologically older, yet physiologically younger, patients is justifiable and good medical practice. Where right ventricular (RV) pacing is necessary and unavoidable, physicians should consider routinely placing RV leads on the RV mid- or outflow tract septum because these location are as good, if not better, for patients than the current practice of RV apical lead placement. In patients with AV block and asymptomatic yet moderate to severely depressed left ventricular systolic function, primary cardiac resynchronization therapy (CRT) should be strongly considered. Compelling clinical trial evidence does not yet exist to indicate that CRT should be the standard of care in patients with AV block and intact left ventricular systolic function. Right ventricular septal lead placement remains a reasonable option.
Collapse
Affiliation(s)
- Simon Modi
- Arrhythmia Service, London Health Sciences Centre, London, ON, Canada,
| | | | | |
Collapse
|
16
|
Huang CC, Tuan TC, Fong MC, Lee WS, Kong CW. Predictors of inappropriate atrial sensing in long-term VDD-pacing systems. Europace 2010; 12:1251-5. [DOI: 10.1093/europace/euq190] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
17
|
Sincronía auriculo-ventricular en pacientes portadores de marcapasos con estimulación VDD. Estudio descriptivo de un periodo de 14 años. Med Intensiva 2010; 34:303-9. [DOI: 10.1016/j.medin.2010.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Revised: 01/08/2010] [Accepted: 01/12/2010] [Indexed: 11/18/2022]
|
18
|
Blich M, Suleiman M, Shwiri TZ, Marai I, Boulos M, Amikam S. Long-term outcome of atrial synchronous mode pacing in patients with atrioventricular block using a single lead. Clin Cardiol 2010; 33:18-22. [PMID: 20063297 DOI: 10.1002/clc.20695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
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-based pacing (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 oversensing were 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.
Collapse
Affiliation(s)
- Miry Blich
- Rambam Health Care Campus, Pacing and Electrophysiology Unit, Bat Galim Halfa, Israel. M
| | | | | | | | | | | |
Collapse
|
19
|
Panicker GK, Desai B, Lokhandwala Y. Choosing pacemakers appropriately. HEART ASIA 2009; 1:26-30. [PMID: 27325922 DOI: 10.1136/ha.2008.000265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Accepted: 01/20/2009] [Indexed: 11/04/2022]
Abstract
The range of implantable cardiac pacing devices has expanded, with the advances in available technology. Indications for cardiac pacing devices, that is pacemakers, implantable cardioverter defibrillators (ICDs) and cardiac resynchronisation therapy devices (CRTs), have expanded for the treatment, diagnosis and monitoring of bradycardia, tachycardia and heart failure. While the need for pacemakers is increasing, not all patients who require pacemakers are receiving them, especially in the Asia-Pacific region. There is a need to be more critical in advising the use of more expensive devices like ICDs and CRT/CRT-D devices, since most patients in the Asia-Pacific region pay out of pocket for these therapies. The AHA-ACC guidelines need not be blindly followed, since they are too wide-sweeping and are often based on the intention-to-treat basis of trials rather than on the parameters of the patients actually enrolled.
Collapse
Affiliation(s)
| | - B Desai
- Quintiles ECG Services, Mumbai, India
| | | |
Collapse
|
20
|
Busacca P, Gheller G, Pupita M, Berzigotti G, Generali CA, De Crescentini S, Gerardi P, Agostini A, Frattini C, Corbucci G, Papi S. Long-term follow-up of patients paced in VDD mode for advanced atrioventricular block: a pilot study. J Cardiovasc Med (Hagerstown) 2008; 9:39-42. [DOI: 10.2459/jcm.0b013e328011e6b3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
21
|
Schaer BA, Weinbacher M, Zellweger MJ, Sticherling C, Osswald S. Value of VDD-pacing systems in patients with atrioventricular block: Experience over a decade. Int J Cardiol 2007; 122:239-43. [PMID: 17289175 DOI: 10.1016/j.ijcard.2006.11.086] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Revised: 10/30/2006] [Accepted: 11/11/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Even though current guidelines suggest the use of VDD pacemakers in patients with AV block and normal sinus node function, a DDD system is often preferred for fear of either long-term atrial undersensing or late sinus node dysfunction and the resultant need for system upgrades. METHODS We evaluated the long-term follow-up of all VDD pacemakers implanted in our center between 1992 and 2001 regarding atrial sensing, maintenance of AV synchrony, incidence of atrial fibrillation (AF), or the need for system upgrade, respectively. RESULTS 320 consecutive patients (56% men, age 75+/-13 years) received a VDD pacemaker for the following indications: third-degree AV block 54%, second-degree AV block 34%, fascicular block with first-degree AV block and syncope 6%, others 6%. 138 patients (43%) died during follow-up, 3.8+/-2.3 years after implantation. Follow-up duration was 6.1+/-2.5 years in the remaining patients. At the last follow-up, 268 pacemakers (84%) were programmed to the VDD mode, 47 pacemakers (15%) were permanently programmed to the VVI mode (AF 36, undersensing 7, others 4, respectively). In five patients a DDD upgrade was necessary for sinus node dysfunction (3) or lead defect (2). Lead revision was performed in 19 patients (6%) (ventricular lead dislocation 7, atrial undersensing 6, lead fracture 3, others 2, respectively). CONCLUSION VDD pacemakers have an excellent long-term performance in patients with AV block. They have a very low incidence of lead revisions for atrial undersensing (2%) and DDD upgrades for secondary sinus node dysfunction (1%).
Collapse
Affiliation(s)
- Beat Andreas Schaer
- Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
| | | | | | | | | |
Collapse
|
22
|
Eberhardt F, Schuchert A, Schmitz D, Zerm T, Mitzenheim S, Wiegand UK. Incidence and Significance of Far-Field R Wave Sensing in a VDD-Implantable Cardioverter Defibrillator. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:395-403. [PMID: 17367360 DOI: 10.1111/j.1540-8159.2007.00681.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND A VDD-implantable cardioverter-defibrillator (ICD) provides atrioventricular (AV) synchronous stimulation when necessary and incorporates the advantages of dual chamber arrhythmia discrimination algorithms both at potentially lower costs and less periprocedural complications than a DDD-ICD system. A prerequisite for correct dual chamber ICD function is reliable atrial sensing. METHODS We evaluated atrial near- and ventricular far-field sensing and its impact on the dual-chamber detection algorithm in 106 patients with a single-lead VDD-ICD during a 12-month follow-up period. RESULTS Six hundred and thirty-nine follow-ups were included. Mean near-field amplitude was 3.82 +/- 1.76 mV; mean far-field amplitude was 0.31 +/- 0.15 mV. 46% of patients had far-fields >0.35 mV and 35% of patients showed atrial EGM markers corresponding to a ventricular far-field in at least one follow-up. Six hundred and forty-five tachycardia episodes were evaluated. Due to far-field sensing, three of 66 episodes (4.5%) of sinus tachycardia were misclassified as ventricular tachycardia (VT), leading to antitachycardia therapies. Delayed detection of VT was seen in a 12 of 323 episodes (3.7%) in five of 62 patients (8%) having VT events (delay 6.4 +/- 6.0 seconds (range 2-24 seconds)). Stable far-field amplitudes <0.2 mV in a follow-up had a high negative predictive value for the occurrence of malfunction during tachycardia-conversely, high far-field amplitudes or a high incidence of far-field markers are only moderately correlated with malfunction. CONCLUSIONS Ventricular far-field sensing in a VDD-ICD is not uncommon, however, tachycardia detection by the dual chamber algorithm is not seriously impaired by far-field sensing.
Collapse
Affiliation(s)
- Frank Eberhardt
- Universitätsklinikum Schleswig Holstein Campus Luebeck, Medizinische Klinik II, Luebeck, Germany.
| | | | | | | | | | | |
Collapse
|
23
|
Chabbar Boudet MC, Lukic A, Galache Osuna JG, De Juan Montiel J, Cay Diarte E, Diarte de Miguel JA, Placer Peralta LJ. Seguridad y eficacia de los sistemas de estimulación VDD monosonda. Rev Esp Cardiol 2006; 59:897-904. [PMID: 17020702 DOI: 10.1157/13092797] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES Single-lead VDD pacing provides the physiological benefits of atrioventricular synchrony with the convenience of a single-lead system. However, concern remains about the method's safety and effectiveness. METHOD In total, 700 patients with single-lead VDD pacemakers were evaluated retrospectively. The following parameters were recorded: age, sex, etiology, the symptoms and electrocardiographic diagnosis that justified pacemaker implantation, the venous access route used for implantation, atrial sensing at implantation, atrial undersensing at follow-up, the occurrence of supraventricular tachyarrhythmias, and final pacing mode. RESULTS Third-degree atrioventricular block was the main indication for pacemaker implantation (66.4%). The most commonly used venous access route was via the right cephalic vein (49.1%). At implantation, the mean atrial signal was 1.8 (4 1.15) mV. During follow-up, significant atrial undersensing occurred in 7.7% of patients; in 1.9%, it could not be corrected by device reprogramming. Uncontrollable supraventricular arrhythmias were observed in 6.4% of patients. Symptomatic sinus node disease was rare. By the end of follow-up, 91.4% of patients were still on VDD pacing, while, in 8.3%, the pacemaker had to be reprogrammed to the VVI mode. Only 0.3% required atrial lead implantation for DDD pacing. Left-side venous access during implantation was a independent predictora of atrial undersensing at follow-up. Low values of atrial detection at implant did not reach statistical signification although it showed a remarkable trend. CONCLUSIONS Single-lead VDD pacing seems to be safe and effective when appropriately indicated. Our findings are consistent with those of previously published studies.
Collapse
Affiliation(s)
- Maruan C Chabbar Boudet
- Unidad de Marcapasos, Servicio de Cardiología. Hospital Universitario Miguel Servet, Zaragoza, España.
| | | | | | | | | | | | | |
Collapse
|
24
|
Zupan I, Lipar L, Zizek D, Boute W, Vidmar M, Gabrijelcic T, Rakovec P, Brecelj A. Retrospective analysis of mode survival, reliability of atrial sensing and incidence of atrial tachyarrhythmias in 307 single-lead VDD pacemaker patients. ACTA ACUST UNITED AC 2006; 8:855-8. [PMID: 16891329 DOI: 10.1093/europace/eul091] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AIMS The aim of this retrospective analysis was to investigate VDD mode survival, development of atrial tachyarrhythmias (AT), and long-term atrial sensing performance of VDD pacing systems. METHODS AND RESULTS We implanted single-lead VDD pacemakers in patients with isolated atrioventricular block and performed a retrospective analysis of 307 patients who had their devices implanted between May 1994 and September 2001. In 39 patients (12.7%), the pacing mode had to be reprogrammed to a single-chamber ventricular pacing mode, mostly due to permanent AT. In 16 of these patients, the atrial sensing safety margin was less than 150%. The atrial sensing safety margin was insufficient, i.e. less than 100% in only seven patients. Although only 12 (3.9%) of the patients had a history of paroxysmal AT at the time of pacemaker implantation, 200 (65%) patients presented with AT during follow-up. The mean AT burden at the last follow-up was 2.5%. CONCLUSION These data illustrate that single-lead VDD pacemakers can be applied without serious complications in a highly selected group of patients. Our main concern is the development of AT in a large part of our population. Over a 10-year period, two thirds of our patients presented with AT.
Collapse
Affiliation(s)
- Igor Zupan
- Department of Cardiology, University Medical Centre Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia.
| | | | | | | | | | | | | | | |
Collapse
|
25
|
VDD pacing in dogs: When, why and how to perform single-lead atrial synchronous, ventricular inhibited (VDD) pacing. J Vet Cardiol 2006; 8:25-39. [DOI: 10.1016/j.jvc.2006.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2005] [Revised: 01/19/2006] [Accepted: 01/22/2006] [Indexed: 11/21/2022]
|
26
|
Bauer A, Bauer J, Bauer M, Kelemen K, Voss F, Senges-Becker J, Weretka S, Katus HA, Becker R. [Efficiency potential in the pacemaker/implantable cardioverter defibrillator outpatient clinic]. Herzschrittmacherther Elektrophysiol 2006; 17:26-34. [PMID: 16547657 DOI: 10.1007/s00399-006-0504-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2005] [Accepted: 12/30/2005] [Indexed: 05/07/2023]
Abstract
The aim of the present study was to elucidate whether the duration of a technical follow-up (FU) of a pacemaker (PM)/implantable cardioverter defibrillator (ICD) has an impact on cost-effectiveness in the outpatient clinic. We determined the time required for a complete FU of devices from three different manufacturers. In 130 patients (70 VVI/DDD-PM, 60 VVI/DDD-ICD) with either a PM (Phylos, Chorum/Talent, Kappa, EnPulse) or an ICD (Belos, Alto or GEM) the time was recorded for a complete FU including determination of lead impedance, sensing and pacing threshold. The time for activation of individual menue buttons was excluded. On the basis of time required for FU, cost-units (CU) were calculated for 2000 FU/year and for a presumed device longevity (PM 7 years, ICD 5 years). For VVI-PM, the duration of FU was almost identical for devices from different manufacturers (105+/-11 s to 125+/-8 s; p=n.s.). However, analysis of DDD-PM revealed marked differences (140+/-25 s vs 282+/-23 s, p<0.05). Time for FU of ICDs varied between 108+/-5 s and 207+/-21 s (p<0.05) in VVI-ICDs and between 129+/-8 ms and 225+/-23 s (p<0.05) in DDD-ICDs. The total savings could be 55 000 CU in VVI- and 53 333 CU in DDD-ICDs. For full automatic DDD-pacemakers (EnPulse) time for FU could be reduced to 58+/-3 s (p<0.05). Differences in FU times were caused by problems with telemetry, delay during booting of the programmer, interrogation at the beginning and at the end of FU and for sensing tests. Improving not only programmers and devices but also test automaticity could significantly increase cost-efficiency in the outpatient clinic.
Collapse
Affiliation(s)
- A Bauer
- Abteilung Kardiologie, Pulmologie und Angiologie, Universität Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Bulmer BJ, Sisson DD, Oyama MA, Solter PF, Grimm KA, Lamont L. Physiologic VDD versus Nonphysiologic VVI Pacing in Canine 3rd-Degree Atrioventricular Block. J Vet Intern Med 2006. [DOI: 10.1111/j.1939-1676.2006.tb02855.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
28
|
Eberhardt F, Bode F, Bonnemeier H, Boguschewski F, Schlei M, Peters W, Wiegand UKH. Long term complications in single and dual chamber pacing are influenced by surgical experience and patient morbidity. Heart 2005; 91:500-6. [PMID: 15772212 PMCID: PMC1768857 DOI: 10.1136/hrt.2003.025411] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To determine how short and long term complication rates after pacemaker implantation are influenced by patient morbidity, operator experience, and choice of pacing system. DESIGN Retrospective analysis of 1884 patients who received VVI (n = 610), VDD (n = 371), or DDD devices (n = 903) between 1990 and 2001. Follow up period was 64 (34) months. The influence of age, sex, coronary artery disease, myocardial infarction, reduced left ventricular (LV) function, right ventricular (RV) dilatation, atrial fibrillation, device type, and operator experience on operation time and complication rate were analysed. RESULTS Operation time was prolonged in patients with coronary artery disease, inferior myocardial infarction, reduced LV function, and RV dilatation. Implantation of DDD pacemakers prolonged operation time, particularly among operators with a low or medium level of experience. The overall complication rate was 4.5%. Sixty seven per cent of these complications occurred within the first three months. Complication rate was increased by age, reduced LV function, and RV dilatation. Implantation of DDD systems led to a higher complication rate (6.3%) than implantation of VVI (2.6%) or VDD pacemakers (3.2%). These differences were present only among operators with a low or medium level of experience. CONCLUSIONS Operation time and complication rate increased with age, impaired LV function, and RV dilatation. Complication rates were higher with DDD than with VVI or VDD implantation and were excessive among inexperienced but not experienced operators.
Collapse
Affiliation(s)
- F Eberhardt
- Universitätsklinik Schleswig Holstein, Campus Luebeck, Medizinische Klinik II, Ratzeburger Allee 160, 23538 Luebeck, Germany.
| | | | | | | | | | | | | |
Collapse
|
29
|
Kuzniec J, Golovchiner G, Mazur A, Battler A, Strasberg B. Atrial Signal Amplitude Measurements in VDD Systems According to Body Position. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2004; 27:1344-6. [PMID: 15511242 DOI: 10.1111/j.1540-8159.2004.00637.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Single lead VDD pacing is an established therapy in patients with AV block. Body position may influence the amplitude of the atrial signal recorded through the floating atrial electrode. This study analyzed the degree of posture related variation in the signal amplitude of floating atrial electrodes in 63 patients (mean age 72 +/- 21 years) implanted with a VDD system. The average atrial amplitude in the supine position was 1.59 +/- 1.15 mV and decreased significantly in the sitting position (1.37 +/- 1.08, P < 0.014), right decubitus (1.33 +/- 0.83, P < 0.007), and the abdominal position (1.24 +/- 0.86, P < 0.001). The left side decubitus showed a nonsignificant increase in atrial amplitude (1.66 +/- 1.02, P < 0.64). Body position significantly affects P wave amplitude and may be the cause of intermittent atrial undersensing. P wave amplitude measurement in different body postures should be performed in cases where suspected atrial undersensing occurs.
Collapse
Affiliation(s)
- Jairo Kuzniec
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| | | | | | | | | |
Collapse
|
30
|
|
31
|
Di Donato M, Toso A, Dor V, Sabatier M, Barletta G, Menicanti L, Fantini F. Surgical Ventricular Restoration Improves Mechanical Intraventricular Dyssynchrony in Ischemic Cardiomyopathy. Circulation 2004; 109:2536-43. [PMID: 15159292 DOI: 10.1161/01.cir.0000131610.78457.57] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
In ischemic cardiomyopathy, dyssynchrony of left ventricular (LV) mechanical contraction produces adverse hemodynamic consequences. This study tests the capacity of geometric rebuilding by surgical ventricular restoration (SVR) to restore a more synchronous contractile pattern after a mechanical, rather than electrical, intervention.
Methods and Results—
A prospective study of the global and regional components of dyssynchrony was conducted in 30 patients (58±8 years of age) undergoing SVR at the Cardiothoracic Center of Monaco. The protocol used simultaneous measurements of ventricular volumes and pressure to construct pressure/volume (P/V) and pressure/length (P/L) loops. Angiograms were done before and after SVR to study a 600-ms cycle during atrial pacing at 100 bpm. Mean QRS duration was similar, at 100±17 ms preoperatively and 114±28 ms postoperatively (NS). Preoperative LV contraction was highly asynchronous, because P/V loops showed abnormal isometric phases with a right shifting. Endocardial time motion was either early or delayed at the end-systolic phase so that P/L loops were markedly abnormal in size, shape, and orientation. Postoperatively, SVR resulted in leftward shifting of P/V loops and increased area; endocardial time motion and P/L loops almost normalized to allow a better contribution of single regions to global ejection. The hemodynamic consequences of SVR were improved ejection fraction (30±13% to 45±12%;
P
=0.001); reduced end-diastolic and end-systolic volume index (202±76 to 122±48 and 144±69 to 69±40 mL/m
2
;
P
=0.001); more rapid peak filling rate (1.75±0.7 to 2.32±0.7 EDV/s;
P
=0.0001); peak ejection rate (1.7±0.7 to 2.6±0.9 Sv/s;
P
=0.0002), and mechanical efficiency (0.56±0.15 to 0.65±0.18;
P
=0.04).
Conclusions—
SVR produces a mechanical intraventricular resynchronization that improves LV performance.
Collapse
Affiliation(s)
- Marisa Di Donato
- Department of Critical Care Medicine, University of Florence, Italy.
| | | | | | | | | | | | | |
Collapse
|
32
|
Wiegand UKH, Bode F, Bonnemeier H, Eberhard F, Schlei M, Peters W. Long-Term Complication Rates in Ventricular, Single Lead VDD, and Dual Chamber Pacing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2003; 26:1961-9. [PMID: 14516336 DOI: 10.1046/j.1460-9592.2003.00303.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A higher incidence of pacemaker related complications has been reported in DDD systems as compared to VVI devices. The implantation of single lead VDD pacemakers might reduce the complication rate of physiological pacing in patients with AV block. In a retrospective study, the data records of 1,214 consecutive patients with pacemaker implantation for AV block between 1990 and 2001 (VVI 36.5%, DDD 32.9%, VDD 30.6%) were analyzed. Complications requiring surgical interventions were compared during a follow-up period of 64 +/- 31 months. Operation and fluoroscopic times were longer in DDD pacemaker implantation compared to VDD and VVI devices:58 +/- 23 versus 39 +/- 10 and 37 +/- 13 minutes (P<0.001), 9.2 +/- 5.2 versus 4.1 +/- 2.4 and 3.5 +/- 2.3 minutes, respectively. Differences remained significant after correction for covariates. In a multivariate Cox regression model, the corrected complication hazard of a DDD pacemaker implantation was increased by 3.9 (1.4-11.3) compared to VVI and increased by 2.3 (1.1-4.5) compared to VDD pacing. Higher complication rates in DDD pacing were mainly due to a higher incidence of early reoperation for atrial lead dysfunction, whereas the long-term complication rate was not different from VDD or VVI pacing. Early and long-term complication rates did not differ between VDD and VVI pacemaker systems. In conclusion, operation time and complication rates of physiological pacing are reduced by VDD pacemaker implantation achieving values comparable to VVI pacing. Thus, single lead VDD pacing can be recommended for patients with AV block.
Collapse
Affiliation(s)
- Uwe K H Wiegand
- University of Lübeck, Medizinische Klinik II, Lübeck, Germany.
| | | | | | | | | | | |
Collapse
|
33
|
|
34
|
Chiladakis JA, Patsouras N, Agelopoulos G, Nikolopoulos N, Manolis AS. Comparative three-year performance of chronic atrial sensing among eight different VDD systems. Am J Cardiol 2002; 89:1215-8. [PMID: 12008181 DOI: 10.1016/s0002-9149(02)02310-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- John A Chiladakis
- Cardiology Department, Patras University Hospital, Rio, Patras, Greece
| | | | | | | | | |
Collapse
|