[Is asynchronous ventricular pacemaker stimulation dangerous? Results of an international survey]

The safety of asynchronous ventricular pacemaker stimulation, occurring with magnet application or during noise reversion, is a point of controversial discussions. A survey was performed, to evaluate such complications.

145 pacemaker specialists worldwide were asked about their pacemaker experience and arrhythmia induction due to asynchronous stimulation.

102/145 physicians (70 %) answered. Pacing experience: 3 - 40 y, mean 20 +/- 8 y, cumulative 1,974 y. Pacemaker follow-ups: 50 - 12,000/y, mean 2,326 +/- 2,082, overall 230,305/y. No data: 3. Arrhythmia induction was reported by 34/102 physicians (33 %) in 48 cases. 23 cases were major complications: In 13 pts VT or VF was induced. 4 of these had an ejection fraction < 30 %, one patient died. 10 additional cases without detailed information were included. 4 of these occurred 15 to 20 years ago. No case occurred in the last 7 years. 25 events were induced secondary, or clinically not relevant: 14 cases had asymptomatic PVCs or short runs. 5 cases 20 - 25 years ago, were due to anodal stimulation. 5 events happened during acute myocardial ischemia or electrolyte imbalance immediately after cardiac surgery. One patient had spontaneous VTs as well.

Inducement of ventricular tachyarrhythmias during asynchronous ventricular pacing is an extreme rarity. Patients at risk for these rare events are only those with acute myocardial ischemia or severe electrolyte imbalance, and those with organic cardiac disease, reduced left ventricular function and spontaneous ventricular tachyarrhythmias. Asynchronous ventricular pacing can be considered as safe.