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Long-term follow-up of patients paced in VDD mode for advanced atrioventricular block: a pilot study
Paolo Busacca1, Giuliano Gheller, Mauro Pupita
1Division of Cardiology-Intensive Care Unit, S. Maria della Misericordia Hospital, Urbino, Italy. paolobusacca@aliceposta.it
Insights
This pilot study found that patients with VDD pacemakers have a similar survival trend to the general population. Single-lead VDD pacing in advanced atrioventricular block patients demonstrated comparable long-term outcomes.
Area of Science:
- Cardiology
- Biomedical Engineering
- Geriatric Medicine
Background:
- Advanced atrioventricular block necessitates pacing for survival.
- VDD pacemakers offer single-lead pacing solutions.
- Assessing long-term survival trends in VDD pacemaker recipients is crucial.
Purpose of the Study:
- To estimate the survival trend of patients receiving VDD pacemakers.
- To compare VDD pacemaker patient survival with the general population's survival curve.
Main Methods:
- Pilot study involving 97 patients (mean age 78) with advanced atrioventricular block.
- Implantation of single-lead VDD pacemakers with right ventricular apex stimulation.
- Clinical examinations, telemetric data collection, and cause of death recording.
- Comparison with survival data from the Italian Institute of Statistics (ISTAT) for the Marche Region.
Main Results:
- Mean follow-up of 7 years with 17.5% mortality.
- Atrioventricular synchrony was high (97%) in patients without atrial fibrillation.
- No significant difference in survival probability between VDD patients and the general male population in the Marche Region.
Conclusions:
- Single-lead VDD pacing appears to offer survival outcomes comparable to the general population.
- VDD pacing is a viable long-term solution for selected patients with atrioventricular block.
- Further research may explore specific VDD system performance and patient subgroups.
Objective:
The aim of this pilot study was to estimate the survival trend of patients implanted with VDD pacemakers, and to compare it with the survival curve of the general population of the same region.
Methods:
Ninety-seven patients (65 male, mean age 78 +/- 6 years) with advanced atrioventricular block referred to our institution were implanted with single-lead VDD pacemakers. All patients were stimulated at the right ventricular apex. At each follow-up visit, a clinical examination was performed and telemetric data collected. In case of death, the family was contacted to record the cause of death. Data on the survival probability of the general population in the Marche Region were obtained from the Italian Institute of Statistics (ISTAT).
Results:
During the follow-up (mean 7 +/- 6 years), 17 patients (17.5%) died and eight patients (8.2%) developed atrial fibrillation. Atrioventricular synchrony was 97 +/- 3% in the overall patient population, excluding patients with atrial fibrillation. Only one patient was upgraded to DDD pacing owing to symptomatic loss of atrial sensing; after the upgrading procedure symptoms disappeared. During the follow-up period, 19 pacemakers were replaced for end of life of the battery. Patients who died during follow-up were aged 80 +/- 7 years at implantation and 85 +/- 6 years at death. The comparison between the trend line simulating the patient survival probability of the studied VDD population, and the survival probability of males in the Marche Region did not show any significant difference.
Conclusions:
In patients chronically paced with a single-lead VDD system, survival probability seems to be similar to that of the general population.
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