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Effects of different pacing algorithms on cumulative ventricular pacing proportion in patients with pacemakers
Chun-Hui Xiao1, Xing-Wei Zhang, Ru-Xing Wang
1Department of Cardiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China.
Insights
Managed Ventricular Pacing (MVP) and Search Atrioventricular Conduction Plus (SAV+) significantly reduce cumulative ventricular pacing proportion (CumVP%) compared to conventional dual-chamber pacing. MVP demonstrated the greatest reduction in CumVP%, potentially benefiting patients by minimizing adverse cardiovascular events.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Device Technology
Background:
- Increased cumulative ventricular pacing proportion (CumVP%) is a known risk factor for adverse cardiovascular events.
- Reducing CumVP% is a critical consideration in pacemaker management.
- This study evaluates novel pacing algorithms for their impact on CumVP%.
Purpose of the Study:
- To compare the efficacy of three different pacemaker pacing algorithms in reducing CumVP% in patients.
- To assess the impact of conventional dual chamber rate adaptive pacing (DDDR), Search Atrioventricular Conduction Plus (SAV+), and Managed Ventricular Pacing (MVP) on ventricular pacing.
- To determine which algorithm offers the most significant reduction in CumVP%.
Main Methods:
- Forty-two patients received pacemakers programmed with DDDR, SAV+, and MVP algorithms sequentially over three months.
- Pacing and sensing statuses (AS-VS, AS-VP, AP-VS, AP-VP) were recorded for each algorithm.
- Cumulative ventricular pacing proportions (CumVP%) were calculated and compared across the three algorithms.
Main Results:
- The DDDR algorithm resulted in a CumVP% of 95.1%, SAV+ showed 46.9%, and MVP achieved 19.6% (P < 0.05).
- The percentage of patients achieving CumVP% < 40% was 0% for DDDR, 23.8% for SAV+, and 95.2% for MVP (P < 0.05).
- MVP significantly reduced ventricular pacing compared to both DDDR and SAV+.
Conclusions:
- Both SAV+ and MVP algorithms significantly reduce CumVP% compared to the conventional DDDR algorithm.
- The MVP algorithm demonstrated the most substantial reduction in CumVP%.
- Patients may experience significant benefits from the MVP algorithm due to its effectiveness in lowering CumVP%.
Background:
It is well known that increased cumulative ventricular pacing proportion (CumVP%) is one of the most important causes for adverse cardiovascular events. Therefore, how to reduce CumVP% has been a treatment issue in recent years. This study aimed to investigate the effects of different pacing algorithms on CumVP% in patients with pacemakers.
Methods:
Pacemakers with three pacing algorithms, i.e., conventional dual chamber rate adaptive pacing (DDDR), search atrioventricular conduction plus (SAV+) and managed ventricular pacing (MVP), were implanted in 42 patients including 41 with bradycardia arrhythmias and one with ventricular tachycardia. Pacemakers were programmed to work in conventional DDDR, SAV+ and MVP during the follow-up periods of the first, the second and the third month. In each pacing algorithm, the time percentages of four pacing and sense status including atrial sense-ventricular sense (AS-VS), atrial sense-ventricular pacing (AS-VP), atrial pacing-ventricular sense (AP-VS) and atrial pacing-ventricular pacing (AP-VP) were calculated. Cumulative ventricular pacing proportions were compared in the three pacing algorithms in the first, the second and the third month postoperatively.
Results:
In the DDDR algorithm AS-VS, AS-VP, AP-VS and AP-VP were 2.4%, 52.3%, 2.5% and 42.8% respectively, while in SAV+ they were 19.3%, 34.9%, 33.9% and 12.0%, in MVP they were 38.9%, 13.2%, 41.6% and 6.4%. In the above the DDDR, SAV+ and MVP algorithms, cumulative ventricular pacing proportions were 95.1%, 46.9% and 19.6%, respectively (P < 0.05) and the percentages of CumVP% < 40% in patients were 0, 23.8% and 95.2.0% (P < 0.05).
Conclusions:
Compared with the conventional DDDR algorithm, both SAV+ and MVP significantly reduced the CumVP%, especially the MVP algorithm. Patients may benefit from MVP algorithm due to reduced CumVP%.
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