The effect of VVI pacing on P-wave dispersion in patients with dual-chamber pacemakers

The incidence of atrial fibrillation is higher in patients with VVI pacing mode than DDD pacing mode, but the likely mechanism is not clearly understood. We aimed to evaluate whether short-term VVI pacing increases inhomogeneous atrial conduction by using P-wave dispersion. Forty-seven patients (32 men, 15 women, mean age 54 +/- 13 years) with DDD pacemakers were enrolled in this study. Twelve-lead surface ECGs were obtained in all patients during VDD pacing after an observation period of 1 week. The mode was then changed to VVI and 12 lead surface ECGs were obtained after another 1-week observation period. P-wave durations were calculated in all 12 leads in both VDD and VVI pacing modes. The difference between the maximum and the minimum P-wave duration was defined as the P-wave dispersion (PWD = P(max) - P(min)). P-wave maximum duration (P(max)) calculated in VVI pacing mode was significantly longer than in VDD pacing mode (128 +/- 19 vs 113 +/- 16 ms, P < 0.001). There was no significant difference in the P-wave minimum durations (80 +/- 13 ms vs 79 +/- 12 ms, P = 0.7) between VVI pacing and VDD pacing. The P-wave dispersion value was higher in the VVI pacing mode than in the VDD pacing mode (48 +/- 8 ms vs 34 +/- 7 ms, P < 0.001). Short-term VVI pacing induces prolongation of P(max) and results in increased P-wave dispersion, which might be responsible for the development of atrial fibrillation more frequently in these patients than in those with the VDD pacing mode.