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Efficacy of single lead VDD pacing in patients with impaired and normal left ventricular function
A Schuchert1, M Jakob, N Treese
1Department of Cardiology, University-Hospital Eppendorf, Hamburg, Germany.
Insights
Single lead VDD pacing effectively restores atrial synchronous ventricular pacing in patients with impaired and normal left ventricular (LV) function. This pacing mode offers a viable alternative for managing advanced AV block, even in complex cardiac conditions.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Advanced atrioventricular (AV) block with impaired left ventricular (LV) function presents significant management challenges.
- Atrial synchronous ventricular pacing is considered optimal for these patients, but its efficacy with single-lead systems requires further investigation.
Purpose of the Study:
- To evaluate the long-term efficacy and performance of single-lead VDD pacing in patients with impaired LV function compared to those with normal LV function.
- To assess lead stability, atrial sensing, and pacing mode maintenance over a 12-month follow-up period.
Main Methods:
- A cohort study comparing 33 patients with impaired LV function and 42 with normal LV function, all implanted with a VDD lead and VDDR pacemaker.
- Follow-up assessments at 1, 3, 6, and 12 months included measurement of P wave amplitude and percentage of atrial sensing.
- Pacemaker programming and patient outcomes were systematically recorded.
Main Results:
- Single-lead VDD pacing successfully maintained AV synchronous pacing in a significant majority of patients in both groups at 12 months.
- P wave amplitude and atrial sensitivity thresholds remained comparable between patients with impaired and normal LV function throughout the study.
- Near-permanent atrial sensing (over 99%) was consistently observed in both groups, indicating reliable lead performance.
Conclusions:
- Single-lead VDD pacing is a reliable method for achieving atrial synchronous ventricular pacing in patients with both normal and impaired LV function.
- This pacing strategy can serve as an effective alternative to dual-chamber (DDD) pacemakers in selected patient populations.
- The study supports VDD pacing as a viable option for managing advanced AV block, even in the presence of compromised left ventricular function.
Abstract:
Atrial synchronous ventricular pacing seems to be the best pacing mode for patients with advanced AV block and impaired LV function. The long-term follow-up of single lead VDD pacing was studied in 33 patients with impaired LV function and compared to 42 patients with normal LV function. All patients received the same VDD lead and VDDR pacemaker. The lead model with 13-cm AV spacing between the atrial and ventricular electrode was implanted in 89% of the patients. Follow-ups were 1, 3, 6, and 12 months after implantation. The percentage of atrial sensing and the P wave amplitude were determined at each follow-up. Minimal P wave amplitude at implantation was 2.0 +/- 1.4 mV in patients with impaired and 1.7 +/- 0.9 mV with normal LV function (not significant). At the 12-month follow-up, 33 patients with normal and 23 patients with depressed LV function remained paced in the VDD mode. The remaining patients died in five (impaired LV function) and seven cases (normal LV function) or their pacemakers were programmed to the VVI/VVIR pacing mode in four (impaired LV function) and three cases (normal LV function). P wave amplitude did not differ in the two groups (e.g., at month 12: impaired: 1.17 +/- 0.42 mV; normal: 1.09 +/- 0.49 mV). The atrial sensitivity was programmed in most patients to sensitive settings with no differences between the two groups (e.g., at month 12: impaired: 0.13 +/- 0.06 mV; normal: 0.13 +/- 0.05 mV). The diagnostic counters indicated nearly permanent atrial sensing (e.g., at month 12: impaired: 99.3 +/- 2.2%; normal: 99.0 +/- 1.0 mV). In conclusions, single lead VDD pacing restored AV synchronous ventricular pacing in patients with normal and with impaired LV function indicating that it could be an alternative to DDD pacemakers, but not to dual-chamber pacing.