Upgrade to dual chamber pacing after long-term ventricular stimulation: feasibility and intermediate term follow-up

To evaluate the feasibility and follow-up results of atrial lead implantation and a change to dual chamber pacing following long-term treatment with single chamber ventricular stimulation.

During a 30-month period, 70 consecutive patients with ventricular pacemakers were referred for pulse generator exchange or lead reoperation. Using defined criteria, an upgrade procedure was considered indicated in 34 of the cases (49%); these patients had a mean age of 74.8+/-8.8 years, and had been treated with VVI or VVIR pacing for a mean time of 7.8+/-3.8 years (range 1.8-17). An atrial lead was successfully implanted via ipsilateral subclavian venipuncture through the existing pectoral pacemaker pocket in 33 of the 34 cases (97% of the attempts). Postoperatively, one atrial lead dislodgement was seen, and another patient required atrial lead adjustment due to P wave undersensing. The mean follow-up period was 14+/-10 months. During this time, four patients developed permanent atrial fibrillation (annual incidence 11%. In 82% of the patients in whom an upgrade procedure was attempted, dual chamber pacing was maintained at the end of follow-up.

Restoration of AV synchrony is possible in a substantial proportion of patients treated with long-term ventricular stimulation. Atrial lead placement through ipsilateral subclavian venipuncture is generally feasible, and the vast majority of cases remain in dual chamber pacing with normal function during intermediate term follow-up.