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Long-term complication rates in ventricular, single lead VDD, and dual chamber pacing

Uwe K H Wiegand1, Frank Bode, Hendrik Bonnemeier

  • 1University of Lübeck, Medizinische Klinik II, Lübeck, Germany. uwe.weigand@MEDINF.MU-LUEBECK.DE

Pacing and Clinical Electrophysiology : PACE
|October 1, 2003
PubMed

Insights

Single lead VDD pacemakers may reduce complications in patients with AV block. VDD pacing offers complication rates comparable to VVI systems, with reduced operation times compared to DDD devices.

Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Medical Device Technology

Background:

  • Dual-chamber (DDD) pacemaker systems report higher complication rates than single-chamber (VVI) devices.
  • Atrioventricular (AV) block necessitates pacing, with various device types offering different physiological pacing capabilities.
  • Pacemaker-related complications and procedural times are critical factors in device selection.

Purpose of the Study:

  • To compare complication rates and procedural times of VDD, DDD, and VVI pacemaker implantations in patients with AV block.
  • To evaluate the efficacy of single-lead VDD pacing in reducing complications associated with physiological pacing.
  • To determine if VDD pacing offers an advantage over DDD and VVI systems in terms of safety and efficiency.

Main Methods:

  • Retrospective analysis of 1,214 patients with AV block undergoing pacemaker implantation between 1990 and 2001.
  • Comparison of surgical intervention rates and procedural times (operation and fluoroscopy) across VVI, DDD, and VDD pacing groups.
  • Multivariate Cox regression analysis to assess corrected complication hazards for different pacing systems.

Main Results:

  • DDD pacemaker implantation showed significantly longer operation and fluoroscopic times compared to VDD and VVI devices.
  • The corrected complication hazard was 3.9 times higher for DDD pacing versus VVI and 2.3 times higher versus VDD.
  • Higher DDD complication rates were primarily due to early atrial lead dysfunction; long-term rates did not differ between VDD, VVI, and DDD.
  • No significant difference in early or long-term complication rates was observed between VDD and VVI pacemaker systems.

Conclusions:

  • Single-lead VDD pacemaker implantation reduces operation time and complication rates for physiological pacing.
  • VDD pacing achieves complication rates comparable to VVI pacing.
  • Single-lead VDD pacing is a recommended option for patients with AV block, offering benefits over DDD systems.

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