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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.
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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
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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.
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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
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3
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Affiliation(s)
- Farhan Shahid
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Eduard Shantsila
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
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4
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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.
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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
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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
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Chao TF, Liu CJ, Tuan TC, Liao JN, Lin YJ, Chen TJ, Kong CW, Chen SA. Long-term prognosis of patients older than ninety years after permanent pacemaker implantation: does the procedure save the patients? Can J Cardiol 2014; 30:1196-201. [PMID: 25262861 DOI: 10.1016/j.cjca.2014.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 04/08/2014] [Accepted: 04/09/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The implantation of a permanent pacemaker (PPM) is life-saving for patients with life-threatening bradycardia. However, the effectiveness and prognosis of PPM implantations for extremely old patients (≥ 90 years old) have not been investigated. METHODS From 2001-2012, a total of 108 patients older than 90 years were identified from 2630 consecutive patients receiving PPM implantations in our hospital as the study group. For each study patient, 4 age-, sex-, and comorbidity-matched subjects who did not have the diagnoses of bradyarrhythmias indicated for PPM implantations were selected from the "Taiwan National Health Research Database" to constitute the control group (n = 432). The study end point was all-cause mortality. RESULTS The median age of the study population was 91 (interquartile range, 90-93) years. Among the PPM group, 45 patients died during the follow-up with an annual mortality rate of 18.7%. The risk of mortality did not differ significantly between the study and control groups with a hazard ratio of 1.020 (95% confidence interval, 0.724-1.437; P = 0.912) after the adjustment for age and sex. Procedure-related complications occurred in 7.4% of the patients receiving PPM implants, and pocket hematoma was the most common. The preimplantation history of heart failure and cerebrovascular accident, rather than age, were significant predictors of mortality among PPM recipients. CONCLUSIONS Nonagenarians with severe bradyarrhythmias could retain the same life expectancies as those without bradyarrhythmias through PPM implantations. Extremely old age (≥90 years) should not be a barrier for PPM implants when indications are present.
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Affiliation(s)
- Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Jen Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Public Health and School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Division of Cardiology, Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan.
| | - Jo-Nan Liao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chi-Woon Kong
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; 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, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
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TUAN TACHUAN, LO MENTZUNG, LIN YENNJIANG, HSIEH WANHSIN, LIN CHEN, HUANG NORDENE, LO LIWEI, CHAO TZEFAN, LIAO JONAN, HSIEH YUCHENG, WU TSUJUEY, CHEN SHIHANN. The Use of Signal Analyses of Ventricular Tachycardia Electrograms to Predict the Response of Antitachycardia Pacing in Patients with Implantable Cardioverter-Defibrillators. J Cardiovasc Electrophysiol 2014; 25:411-417. [DOI: 10.1111/jce.12340] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 11/11/2013] [Accepted: 11/26/2013] [Indexed: 11/29/2022]
Affiliation(s)
- TA-CHUAN TUAN
- Division of Cardiology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Faculty of Medicine and Institute of Clinical Medicine; National Yang-Ming University; School of Medicine; Taipei Taiwan
- Division of Cardiology, Taipei Municipal Gan-Dau Hospital; Taipei Taiwan
| | - MEN-TZUNG LO
- Research Center for Adaptive Data Analysis; Analysis and Center for Dynamical Biomarkers and Translational Medicine; National Central University; Jhongli Taiwan R.O.C
| | - YENN-JIANG LIN
- Division of Cardiology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Faculty of Medicine and Institute of Clinical Medicine; National Yang-Ming University; School of Medicine; Taipei Taiwan
| | - WAN-HSIN HSIEH
- Research Center for Adaptive Data Analysis; Analysis and Center for Dynamical Biomarkers and Translational Medicine; National Central University; Jhongli Taiwan R.O.C
- Medical Biodynamics Program; Division of Sleep Medicine; Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts USA
| | - CHEN LIN
- Research Center for Adaptive Data Analysis; Analysis and Center for Dynamical Biomarkers and Translational Medicine; National Central University; Jhongli Taiwan R.O.C
- Department of Psychiatry and Behavioral Sciences; Stanford University School of Medicine; Palo Alto California USA
| | - NORDEN E. HUANG
- Research Center for Adaptive Data Analysis; Analysis and Center for Dynamical Biomarkers and Translational Medicine; National Central University; Jhongli Taiwan R.O.C
| | - LI-WEI LO
- Division of Cardiology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Faculty of Medicine and Institute of Clinical Medicine; National Yang-Ming University; School of Medicine; Taipei Taiwan
| | - TZE-FAN CHAO
- Division of Cardiology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Faculty of Medicine and Institute of Clinical Medicine; National Yang-Ming University; School of Medicine; Taipei Taiwan
| | - JO-NAN LIAO
- Division of Cardiology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Faculty of Medicine and Institute of Clinical Medicine; National Yang-Ming University; School of Medicine; Taipei Taiwan
| | - YU-CHENG HSIEH
- Division of Cardiology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Cardiovascular Center; Taichung Veterans General Hospital; Taichung Taiwan
| | - TSU-JUEY WU
- Division of Cardiology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Cardiovascular Center; Taichung Veterans General Hospital; Taichung Taiwan
| | - SHIH-ANN CHEN
- Division of Cardiology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Faculty of Medicine and Institute of Clinical Medicine; National Yang-Ming University; School of Medicine; Taipei Taiwan
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Wu JT, Dong JZ, Wang SL, Chu YJ, Wang LX, Yang CK. Efficacy of Catheter Ablation for Atrial Fibrillation in Patients With a Permanent Pacemaker for Atrioventricular Block. Int Heart J 2014; 55:489-93. [DOI: 10.1536/ihj.14-099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Jin-Tao Wu
- Department of Cardiology, Henan Provincial People’s Hospital, Zhengzhou University
| | - Jian-Zeng Dong
- Department of Cardiology, Center for Atrial Fibrillation, Beijing Anzhen Hospital, Capital Medical University
| | - Shan-Ling Wang
- Department of Cardiology, Henan Provincial People’s Hospital, Zhengzhou University
| | - Ying-Jie Chu
- Department of Cardiology, Henan Provincial People’s Hospital, Zhengzhou University
| | - Li-Xia Wang
- Department of Cardiology, Henan Provincial People’s Hospital, Zhengzhou University
| | - Chao-Kuan Yang
- Department of Cardiology, Henan Provincial People’s Hospital, Zhengzhou University
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Petrač D, Radeljić V, Delić-Brkljačić D, Manola Š, Cindrić-Bogdan G, Pavlović N. Persistent atrial fibrillation is associated with a poor prognosis in patients with atrioventricular block and dual-chamber pacemaker. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:695-702. [PMID: 22452373 DOI: 10.1111/j.1540-8159.2012.03376.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The prognostic significance of development of persistent atrial fibrillation (AF) in patients with atrioventricular (AV) block and dual chamber (DDD) pacemakers has not been separately investigated. We sought to determine whether persistent AF influences clinical outcome in these patients. METHODS Three hundred-eight consecutive patients with second- or third-degree AV block and implanted a DDD pacemaker were followed for 36 ± 20 months and retrospectively divided into two groups. Thirty-four patients who developed persistent AF formed persistent AF group, and 278 patients who remained free of this arrhythmia control group. Clinical and outcome data of the two groups were compared. The primary outcome was cardiovascular death. RESULTS The primary outcome occurred more often among the patients in the persistent AF group (6.8% per year) than among those in the control group (2.9% per year; P = 0.028). This difference was primarily because of higher rate of heart failure-related deaths in the persistent AF group (P = 0.009). Secondary outcomes, hospitalization for heart failure and paroxysmal AF episode ≥5 minutes, occurred also more often among the patients in the persistent AF group (P = 0.008 and P < 0.001, respectively), although the risk of nonfatal stroke was similar in both groups (P = 0.628). CONCLUSION In patients with second- or third-degree AV block and DDD pacemaker, the development of persistent AF is associated with an increased risk of cardiovascular death and heart failure.
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Affiliation(s)
- Dubravko Petrač
- Bogdan Cardiology Polyclinic, Zagreb, Croatia. d.petrac@inet-hr
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10
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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
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Hartung D, Thiele L, Hartung WM. [Atrial sensing with fixed and floating electrodes at identical activities]. Herzschrittmacherther Elektrophysiol 2009; 20:39-42. [PMID: 19421839 DOI: 10.1007/s00399-009-0037-6] [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: 02/08/2009] [Accepted: 02/19/2009] [Indexed: 05/27/2023]
Abstract
Despite advantages of single-lead VDD systems, the frequency of implantation of these pacemakers in patients with symptomatic atrioventricular block and normal sinus rhythm continues to decline. Therefore, data comparing the atrial sensing performance of floating and fixed electrodes at identical activities are rare. The aim of the study was to investigate atrial sensing via floating and fixed atrial electrodes at identical activity levels (supine position, left side position, seated position, hyperventilation, standing, walking, fast walking, walking up and down stairs, for 1.5 min each) by beat-to-beat analysis in 24 h Holter ECG. A total of 42 patients were included in the study (22 patients with a DDD system; 20 patients with a VDD system). In 45% of the DDD systems and only in 20% of the VDD systems an intermittent atrial undersensing during activity was recorded (p = 0.0024). The intermittent atrial undersensing in both groups was detected significantly more often in the first 15 s of an activity (p < 0.001). Floating sensing reduced the frequency of atrial undersensing in the initial phase of the activity significantly compared to atrial sensing by a fixed electrode (p = 0.0347). This advantage of floating electrodes and the significant earlier atrial signal recognition by floating electrodes might be useful in future DDD pacemakers by combining a VDD electrode with a fixed atrial electrode.
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Affiliation(s)
- D Hartung
- Institut für Radiologie, Medizinischen Hochschule Hannover, Hannover, Deutschland
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12
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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]
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13
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Amit G, Katz A, Bar-On S, Gilutz H, Wagshal A, Ilia R, Henkin Y. Association of statin therapy and the risk of atrial fibrillation in patients with a permanent pacemaker. Clin Cardiol 2006; 29:249-52. [PMID: 16796074 PMCID: PMC6654340 DOI: 10.1002/clc.4960290605] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Recent studies have shown conflicting results regarding a protective effect of statin therapy on atrial fibrillation (AF). HYPOTHESIS We sought to determine whether statins are effective in reducing the risk of developing arrhythmia in a cohort of 264 patients (49% women, mean age [+/-standard deviation] 71 [+/-12] years) with permanent pacemakers who are at high risk for AF. METHODS All patients who underwent implantation of a permanent pacemaker over a 3-year period were eligible for inclusion in the study. We excluded patients with AF at implantation, incomplete medication information, or less than a yearly follow-up visit. Atrial fibrillation was diagnosed by ECG documentation, pacemaker interrogation, and Holter monitoring. Statin treatment was verified through a central pharmacy-computerized database (for most patients) or by chart review. Of the 264 patients, 36% had coronary artery disease. RESULTS Atrial fibrillation developed in 70 patients (26%) at a median of 359 days post pacemaker implantation. The incidence rate for the first occurrence of AF post pacemaker implantation among patients treated and not treated with statins was 10.5 versus 9.8 events per 100 patient-years, respectively (p = 0.81). Even after controlling for baseline differences, the hazard ratio (HR) for developing AF among statin users did not achieve statistical significance (HR = 0.59 [0.31-1.12]). CONCLUSIONS We could not demonstrate that statin therapy had a protective effect against the risk of AF in patients implanted with a permanent pacemaker. The low prevalence of coronary artery disease in our patients may partly explain our results.
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Affiliation(s)
- Guy Amit
- Cardiology Department, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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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.
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Affiliation(s)
- Igor Zupan
- Department of Cardiology, University Medical Centre Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia.
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15
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Huang C, Tuan T, Lee W, Cheng C, Lin S, Kong C. Long-term efficacy and stability of atrial sensing in VDD pacing. Clin Cardiol 2005; 28:203-7. [PMID: 15869057 PMCID: PMC6654724 DOI: 10.1002/clc.4960280412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The efficacy and stability of atrial electrode sensing function is essential in maintaining atrioventricular (AV) synchrony and activity response in VDD pacing. Studies to evaluate the relationship between atrial sensing efficacy, stability, and implantation strategy are few. HYPOTHESIS This study sought to determine the possible predictors, among the recipients' underlying clinical conditions and the implantation strategies used, of achieving the most stable and effective atrial sensing. METHODS Eighty consecutive adults implanted with VDD pacemakers were studied retrospectively. Atrial electrodes were positioned where the optimal atrial potentials (APs) were measured during implantation. Interrogation parameters, including AV-synchrony ratio, were acquired immediately post implantation, at 1 year, and at 2 years after pacemaker implantation. Appropriate atrial sensing efficacy was defined as AV-synchrony ratio > or = 90%. The stability of atrial sensing was evaluated by the variation ranges of measured APs. RESULTS The measured APs showed no statistical difference when age, gender, or comorbidity was considered. However, with pacing-lead bending angles < or = 90 degrees, patients may have presented with larger APs and narrower AP variation than patients with obtuse angles. There were no clinical parameters in our study that could have predicted the proper atrial sensing efficacy with an AV-synchrony ratio > or = 90%. CONCLUSIONS The long-term sensing efficacy and stability of VDD pacing is reliable. More sophisticated implantation strategies may further improve the atrial sensing stability and efficacy in VDD pacing.
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Affiliation(s)
- Chun‐Yao Huang
- Division of Cardiovascular Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ta‐Chuan Tuan
- Division of Cardiovascular Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang‐Ming University, Taipei, Taiwan
| | - Wen‐Shin Lee
- Division of Cardiovascular Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang‐Ming University, Taipei, Taiwan
| | - Chien‐Ming Cheng
- Division of Cardiovascular Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shing‐Jong Lin
- Division of Cardiovascular Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang‐Ming University, Taipei, Taiwan
| | - Chi‐Woon Kong
- Division of Cardiovascular Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang‐Ming University, Taipei, Taiwan
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