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Burri H, Starck C, Auricchio A, Biffi M, Burri M, D'Avila A, Deharo JC, Glikson M, Israel C, Lau CP, Leclercq C, Love CJ, Nielsen JC, Vernooy K, Dagres N, Boveda S, Butter C, Marijon E, Braunschweig F, Mairesse GH, Gleva M, Defaye P, Zanon F, Lopez-Cabanillas N, Guerra JM, Vassilikos VP, Martins Oliveira M. EHRA expert consensus statement and practical guide on optimal implantation technique for conventional pacemakers and implantable cardioverter-defibrillators: endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and the Latin-American Heart Rhythm Society (LAHRS). Europace 2021; 23:983-1008. [PMID: 33878762 DOI: 10.1093/europace/euaa367] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
With the global increase in device implantations, there is a growing need to train physicians to implant pacemakers and implantable cardioverter-defibrillators. Although there are international recommendations for device indications and programming, there is no consensus to date regarding implantation technique. This document is founded on a systematic literature search and review, and on consensus from an international task force. It aims to fill the gap by setting standards for device implantation.
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Affiliation(s)
- Haran Burri
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Augustenburger Pl. 1, 13353 Berlin, Germany.,German Center of Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Steinbeis University Berlin, Institute (STI) of Cardiovascular Perfusion, Berlin, Germany
| | - Angelo Auricchio
- Fondazione Cardiocentro Ticino, Via Tesserete 48, CH-6900 Lugano, Switzerland
| | - Mauro Biffi
- Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Università di Bologna, Bologna, Italy
| | - Mafalda Burri
- Division of Scientific Information, University of Geneva, Rue Michel Servet 1, 1211 Geneva, Switzerland
| | - Andre D'Avila
- Serviço de Arritmia Cardíaca-Hospital SOS Cardio, 2 Florianópolis, SC, Brazil.,Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | | | - Carsten Israel
- Department of Cardiology, Bethel-Clinic Bielefeld, Burgsteig 13, 33617, Bielefeld, Germany
| | - Chu-Pak Lau
- Division of Cardiology, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | | | - Charles J Love
- Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Radboud University Medical Center (Radboudumc), Nijmegen, The Netherlands
| | | | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, 31076 Toulouse, France
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg, Chefarzt, Abteilung Kardiologie, Berlin, Germany
| | - Eloi Marijon
- University of Paris, Head of Cardiac Electrophysiology Section, European Georges Pompidou Hospital, 20 Rue Leblanc, 75908 Paris Cedex 15, France
| | | | - Georges H Mairesse
- Department of Cardiology-Electrophysiology, Cliniques du Sud Luxembourg-Vivalia, rue des Deportes 137, BE-6700 Arlon, Belgium
| | - Marye Gleva
- Washington University in St Louis, St Louis, MO, USA
| | - Pascal Defaye
- CHU Grenoble Alpes, Unite de Rythmologie, Service De Cardiologie, CS10135, 38043 Grenoble Cedex 09, France
| | - Francesco Zanon
- Arrhythmia and Electrophysiology Unit, Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | | | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universidad Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Vassilios P Vassilikos
- Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.,3rd Cardiology Department, Hippokrateio General Hospital, Thessaloniki, Greece
| | - Mario Martins Oliveira
- Department of Cardiology, Hospital Santa Marta, Rua Santa Marta, 1167-024 Lisbon, Portugal
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Nantsupawat T, Li JM, Benditt DG, Adabag S. Contralateral pneumothorax and pneumopericardium after dual-chamber pacemaker implantation: Mechanism, diagnosis, and treatment. HeartRhythm Case Rep 2018; 4:256-259. [PMID: 29922585 PMCID: PMC6006483 DOI: 10.1016/j.hrcr.2018.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
| | - Jian-Ming Li
- Division of Cardiology, Minneapolis VA Medical Center, Minneapolis, Minnesota
| | - David G Benditt
- Division of Cardiology, University of Minnesota, Minneapolis, Minnesota
| | - Selcuk Adabag
- Division of Cardiology, Minneapolis VA Medical Center, Minneapolis, Minnesota
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3
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Li CY, Gao BL, Pan T, Xiang C, Liu XW, Yang HQ, Yi LY, Liao QB. Morphologic classification of the right auricule on 256-slice computed tomography. Surg Radiol Anat 2016; 39:657-662. [PMID: 27864594 DOI: 10.1007/s00276-016-1785-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 11/15/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the shape of right auricule on 256-slice computed tomography (CT). MATERIALS AND METHODS Five hundred people (250 men, age range 16-84 years) who had cardiac multidetector CT angiography were recruited in this study. All patients had normal sinus rhythm with normal blood pressure (<140/90 mmHg for systolic/diastolic pressure). The morphology of the right auricule was studied and compared after reconstruction of the raw images. RESULTS All patients successfully had cardiac CT angiography (100%), and the right auricule morphology was divided into five types and nine subtypes, including Type I of triangular shape (Ia and Ib), Type II of M shape (IIa and IIb), Type III of L shape (IIIa and IIIb), Type IV of reverse L shape (IVa and IVb), and Type V of balanced shape. The most common type of right auricule is Type IV (28.4%) followed by Type II (24.0%), whereas the least common is Type V (11.0%). Type Ia was present significantly (P < 0.0001) more frequently in females than in males, whereas Type IIa significantly (P = 0.042) more frequently in males than females. No other significant (P > 0.05) sex difference existed in the constitution ratio of the types. The normal angle was greater in Type Ib than in Ia. The greater the normal angle in Type I, the greater the deviation of the right auricule tip towards the left. CONCLUSION A good understanding of the right auricule anatomical morphology can better guide atrial pacing, radiofrequency ablation and other surgical procedures while preventing possible intra-procedural complications.
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Affiliation(s)
- Cai-Ying Li
- Department of Medical Imaging, The Second Hospital, Hebei Medical University, 215 West Heping Road, Shijiazhuang, 050000, Hebei, People's Republic of China.
| | - Bu-Lang Gao
- Department of Medical Research, Shijiazhuang First Hospital, Hebei Medical University, 36 Fanxi Road, Shijiazhuang, 050011, Hebei, People's Republic of China.
| | - Tong Pan
- Department of Medical Imaging, The Second Hospital, Hebei Medical University, 215 West Heping Road, Shijiazhuang, 050000, Hebei, People's Republic of China
| | - Cheng Xiang
- Department of Medical Research, Shijiazhuang First Hospital, Hebei Medical University, 36 Fanxi Road, Shijiazhuang, 050011, Hebei, People's Republic of China
| | - Xiao-Wei Liu
- Department of Medical Imaging, The Second Hospital, Hebei Medical University, 215 West Heping Road, Shijiazhuang, 050000, Hebei, People's Republic of China
| | - Hai-Qing Yang
- Department of Medical Imaging, The Second Hospital, Hebei Medical University, 215 West Heping Road, Shijiazhuang, 050000, Hebei, People's Republic of China
| | - Lan-Ying Yi
- Department of Medical Imaging, The Second Hospital, Hebei Medical University, 215 West Heping Road, Shijiazhuang, 050000, Hebei, People's Republic of China
| | - Qi-Bin Liao
- Department of Medical Imaging, The Second Hospital, Hebei Medical University, 215 West Heping Road, Shijiazhuang, 050000, Hebei, People's Republic of China
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Morphology of right atrial appendage for permanent atrial pacing and risk of iatrogenic perforation of the aorta by active fixation lead. Heart Rhythm 2015; 12:744-50. [DOI: 10.1016/j.hrthm.2014.12.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Indexed: 11/20/2022]
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A long-term, prospective, cohort study on the performance of right ventricular pacing leads: comparison of active-fixation with passive-fixation leads. Sci Rep 2015; 5:7662. [PMID: 25563218 PMCID: PMC4288218 DOI: 10.1038/srep07662] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 12/03/2014] [Indexed: 11/24/2022] Open
Abstract
Active-fixation pacing leads allow the use of selective pacing sites. We evaluated their long-term performance versus passive-fixation leads in 199 newly implanted patients (n = 100 active and n = 99 passive). Postoperative pacing thresholds in the active group were higher than in the passive group (0.85 ± 0.31 V vs. 0.53 ± 0.21 V at baseline, P < 0.001). The active thresholds fell to 0.72 ± 0.23 V at 5 years with a significant drop at one month (0.68 ± 0.53 V, P = 0.003). The passive thresholds slightly increased to 0.72 ± 0.31 V at five years. Differences between groups were significant until three years (all P < 0.05). Active impedances were generally lower than passive impedances (600.44 ± 94.31Ω vs. 683.14 ± 110.98Ω at baseline), and both showed significant reductions at one month to 537.96 ± 147.43Ω in the active group, and after three months to 643.85 ± 82.40Ω in the passive group (both P < 0.01 vs. baseline). Impedance differences between groups were significant until four years (all P < 0.05). Adverse events included thresholds over 1 V, 5 of 6 active and 2 of 5 passive leads returned to below 1 V. One active left ventricular lead dislodged. One passive left subclavian lead insulation fracture occurred. Thus Active fixation pacing leads are stable in a five-year long-term follow up. There was no difference between active and passive leads in terms of electrical performance.
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Dipoce J, Bernheim A, Spindola-Franco H. Radiology of cardiac devices and their complications. Br J Radiol 2014; 88:20140540. [PMID: 25411826 DOI: 10.1259/bjr.20140540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This article familiarizes the reader with several different cardiac devices including pacemakers and implantable cardioverter defibrillators, intra-aortic balloon pumps, ventricular assist devices, valve replacements and repairs, shunt-occluding devices and passive constraint devices. Many cardiac devices are routinely encountered in clinical practice. Other devices are in the early stages of development, but circumstances suggest that they too will become commonly found. The radiologist must be familiar with these devices and their complications.
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Affiliation(s)
- J Dipoce
- 1 Department of Radiology, Hadassah Medical Center, Jerusalem, Israel
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Silvetti MS, Drago F, Ravà L. Long-term outcome of transvenous bipolar atrial leads implanted in children and young adults with congenital heart disease. Europace 2012; 14:1002-7. [PMID: 22379180 DOI: 10.1093/europace/eus024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Atrial leads are often implanted in paediatric patients needing a pacemaker (PM). The aim of this study is the evaluation of their outcome in young patients. METHODS AND RESULTS We evaluated transvenous atrial leads outcome in children and young adults from a single centre, with a retrospective analysis. A P< 0.05 was considered significant. Between 1992 and 2008, 110 patients, 75 with congenital heart defects (d-transposition of great arteries status/post, s/p, Mustard 41%, atrioventricular septal defect 11%, tetralogy 9%, ventricular septal defect 8%), aged 13.3 ± 5.3 years, underwent PM implantation with bipolar atrial transvenous leads for sinus node dysfunction (50%), atrioventricular block (38%), cardiomyopathies, and primary ventricular arrhythmias (12%). Leads are steroid-eluting (98%), tined (59%), screw-in (41%), polyurethane-insulated (72%), silicone-insulated (28%), and have been positioned by transcutaneous puncture of subclavian vein into right atrial appendage/remnant (RAA, 50%), right atrial free wall/septum (25%), left atrium (s/p Mustard, 25%). Follow-up duration is 6.4 ± 4.8 (range 0.1-18) years. At multivariate analysis, younger age at implant was a risk factor for lead failure (4 leads, 3.5%) (P= 0.03); 16 leads (14%) dislodged post-implantation and 12 were successfully repositioned, the others extracted or abandoned. Dislocation occurred more frequently with screw-in leads (P= 0.03) positioned outside RAA (P= 0.02). Atrial threshold showed a small but significant increase, 0.002 V/month (P< 0.001), impedance showed a decrease (0.6 Ω/month, P< 0.001), P-wave showed no significant difference. CONCLUSIONS Transvenous bipolar atrial leads have good long-term results in young patients, with a very low rate of lead failure. Older age at implant can further reduce this rate. Lead dislodgement is frequent in the post-operative period.
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Affiliation(s)
- Massimo Stefano Silvetti
- Paediatric Arrhythmology Unit and Syncope Unit, Paediatric Cardiology and Heart-Surgery Department, Bambino Gesù Children's Hospital, IRCCS Rome, Italy.
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GLIKSON MICHAEL, LURIA DAVID. The Choice of an Atrial Lead-To Each His/Her Own. Pacing Clin Electrophysiol 2011; 34:323-4. [DOI: 10.1111/j.1540-8159.2010.02985.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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9
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ZOPPO FRANCO, ZERBO FRANCESCA, BRANDOLINO GLAUCO, BACCHIEGA ENRICO, LUPO ANTONIO, BERTAGLIA EMANUELE. Straight Screw-In Atrial Leads “J-Post Shaped” in Right Appendage Versus J-Shaped Systems for Permanent Atrial Pacing: A Safety Comparison. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:325-30. [DOI: 10.1111/j.1540-8159.2010.02986.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Luria DM, Feinberg MS, Gurevitz OT, Bar-Lev DS, Granit C, Tanami N, Eldar M, Glikson M. Randomized Comparison of J-Shaped Atrial Leads with and without Active Fixation Mechanism. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:412-7. [PMID: 17367362 DOI: 10.1111/j.1540-8159.2007.00683.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND In this prospective, randomized, controlled study, we compared the performance of J-shaped active fixation (AF) atrial leads with J-shaped passive fixation (PF) leads, over a 1-year follow-up period. METHODS A total of 200 consecutive patients were prospectively randomized for implantation with a Medtronic 5568 AF lead model (n = 103; Minneapolis, MN, USA) versus a Medtronic 5592 PF model (n = 97), and all lead-related measurements and complications were recorded over one year. RESULTS All leads were successfully implanted with a nonsignificant difference in crossover rate to the alternative lead due to failed implantation (1 in the AF and 4 in the PF group, P = NS). Fluoroscopy time during implantation procedure was significantly shorter in the PF group (2.1 +/- 3.6 vs 3.3 +/- 4.5 minute, P < 0.05). Pacing thresholds during implantation were significantly lower in patients with PF leads (0.7 +/- 0.3 V vs 0.9 +/- 0.3 V, P < 0.001) and this difference persisted at 1-year follow-up (0.8 +/- 0.6 V vs 1.3 +/- 0.9 V in PF and AF leads respectively, P < 0.05). Lead-related complications occurred in PF and AF with similar frequency (4% and 9% respectively, P = 0.2). However, pericardial complications occurred only in the AF group (6 cases, P = 0.01). Lead dislodgement was observed in only two cases-both in the PF group (P = 0.3). CONCLUSION Both types of J-shaped atrial leads had reasonable performance. PF leads required shorter fluoroscopy time for implantation, demonstrated a better pacing threshold over a 1-year follow-up period and had no pericardial complications, while AF lead implantation was complicated by pericardial irritation and/or effusion in 6% cases (P = 0.01).
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Affiliation(s)
- David M Luria
- Heart Institute, Sheba Medical Center, Tel Hashomer, the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Luria D, Bar-Lev D, Gurevitz O, Granit H, Rotstein Z, Eldar M, Glikson M. Long-Term Performance of Screw-In Atrial Pacing Leads: A Randomized Comparison of J-Shaped and Straight Leads. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2005; 28:898-902. [PMID: 16176526 DOI: 10.1111/j.1540-8159.2005.00204.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE In this prospective, randomized, control study we compared performance of J-shaped (JL) and straight atrial leads (SL) with active (screw-in) fixation mechanism, over a 5-year follow-up period. SUBJECTS AND METHODS A total of 208 consecutive patients were randomized for implantation with a Medtronic 4568 JL model (n = 103) versus a Medtronic 4068 SL model (n = 105), and all lead-related measurements and complications were recorded. RESULTS Lead-related complications occurred in JL and SL with similar frequency (6% and 9%, respectively, P = 0.45). Lead dislodgment occurred in 8 (7.8%) cases in SL versus none in JL (P = 0.004). Lead malfunction and excessive pacing thresholds without macrodislodgment occurred more frequently in JL (11; 10.7%) than in SL (4; 3.8%), P = 0.055. Lead material failure (insulation break) occurred only once in SL at the 5-year checkup. Most complications occurred during the first year after implantation. Other events occurred in both leads with similar frequency and included: death in 39 and 35, loss of follow-up in 8 and 6, and development of atrial fibrillation in 9 and 15 patients, respectively. Of those who completed follow-up, lead impedance and pacing threshold increased significantly in both groups. P wave decreased in SL but not in JL. CONCLUSION More dislocations occurred in SL, but were counterbalanced by more lead malfunctions and excessive pacing thresholds in the JL group. Both leads demonstrated minor deterioration in electrical measurements during follow-up, with only 1 case of lead material failure in SL. Overall, both groups demonstrated favorable lead performance throughout follow-up.
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Affiliation(s)
- David Luria
- Heart Institute, Sheba Medical Center, Tel Hashomer 52621, Israel.
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Antonelli D, Freedberg NA, Rosenfeld T. Unsuccessful Rescrewing of a Dislodged Screw-In Atrial Lead. Pacing Clin Electrophysiol 2004; 27:692. [PMID: 15125736 DOI: 10.1111/j.1540-8159.2004.00514.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report a case of unsuccessful rescrewing of an atrial lead after its early dislodgment in a 64 years old patient because of entrapped endocardial tissue in the screw-in system.
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Affiliation(s)
- Dante Antonelli
- Department of Cardiology, Ha 'Emek Medical Center, Afula, Israel.
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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.
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Affiliation(s)
- Uwe K H Wiegand
- University of Lübeck, Medizinische Klinik II, Lübeck, Germany.
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