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Long-term follow-up of single-lead VDD pacing
Miroslav J Munclinger1, Andrew S Thornton, Freddie Dateling
1Abu Dhabi, United Arab Emirates.
Insights
Single-lead VDD pacing offers reliable, long-term physiological pacing for heart block patients. Routine follow-up testing over four years does not require postural changes, simplifying patient management.
Area of Science:
- Cardiology
- Biomedical Engineering
- Electrophysiology
Background:
- Single-lead VDD pacing is a method for managing heart block.
- Understanding long-term outcomes is crucial for patient care and device management.
Purpose of the Study:
- To evaluate the long-term efficacy and reliability of single-lead VDD pacing.
- To assess the impact of time and physiological maneuvers on pacing parameters.
Main Methods:
- Retrospective and prospective analysis of 81 patients with single-lead VDD pacemakers implanted between 1993-1997.
- Follow-up assessments included evaluation of pacing modes, sensed P-wave amplitude, and heart rate variability over several years.
Main Results:
- High rates of A-V synchronous pacing (91.9-94.9%) were maintained long-term.
- A significant decrease in chronic sensed P-wave amplitude was observed, independent of implant amplitude and postural changes.
- Intermittent asynchronous ventricular pacing (>10%) occurred in 19.1% of patients.
- Heart rate histograms remained stable, with a dominant rate of 70-79 bpm.
Conclusions:
- Single-lead VDD pacing is a reliable long-term solution for physiological pacing in heart block.
- Routine post-implant testing beyond four years does not necessitate postural maneuvers.
- Pacing system performance remains stable, but P-wave sensing requires careful monitoring.
Abstract:
Long-term outcomes of single-lead VDD pacing were studied retrospectively and partly prospectively. Records were analysed of 81 patients out of 133 in whom a single-lead VDD pacemaker was implanted between January 1993 and December 1997 and who attended a follow-up clinic more than two years after the implant. Forty-eight of them attended a prospective follow-up 54 +/- 15 months after the implant. Sinus rhythm was present in 91.5% of the patients and atrial fibrillation in the remaining 8.5%. A-V synchronous pacing was documented in 91.9 to 94.9% at different follow-up periods; however, an intermittent asynchronous ventricular (VVI) pacing of more than 10% occurred intermittently in 19.1% of the patients. Chronic sensed P-wave amplitude was significantly lower than the implant P-wave amplitude (by 70%) and did not correlate with the implant amplitude. Postural changes (supine, sitting, standing, with normal breathing and during deep inspiration) did not have a significant impact on sensed P-wave amplitude more than four years after the implant. Rate histograms were remarkably stable over the years, with dominant heart rate 70 to 79 beats per minute observed for 25 to 30% of the monitored periods. Single-lead VDD pacing was found to be a reliable method of long-term physiological pacing in patients with heart block who returned for follow-up. Routine testing more than four years after the implant does not require postural manoeuvres.