Related Experiment Videos
[Experience with dual-chamber pacemakers at the Valencia General Hospital]
J Aranda1, F Ridocci, A Fernández
1Servicios de Cardiología, Hospital General Universitario de Valencia.
Insights
Dual chamber pacemakers offer good outcomes for sick sinus syndrome patients but chronic atrial fibrillation limits DDD pacing system effectiveness. Complications were infrequent in this study.
Area of Science:
- Cardiology
- Biomedical Engineering
Context:
- Dual chamber pacemakers are crucial for managing cardiac conduction disturbances.
- Atrioventricular (AV) block and sick sinus syndrome (SSS) are common indications for pacing.
Purpose:
- To evaluate the clinical experience and outcomes of dual chamber (DDD) pacemakers in patients with AV block and SSS.
- To identify complications and limitations associated with DDD pacing.
Summary:
- This study followed 70 patients (mean age 64.5) with AV block or SSS who received DDD pacemakers.
- Low complication rates (15.6%) were observed, primarily atrial channel issues, with chronic atrial fibrillation being a key limitation.
- Outcomes were good for SSS patients, but 15.6% could not maintain dual chamber pacing due to complications or death.
Impact:
- DDD pacing demonstrates a low complication rate and good outcomes for SSS, but atrial fibrillation poses a significant challenge.
- Findings inform clinical decisions regarding pacemaker selection and management strategies for complex cardiac conditions.
Abstract:
We report our experience with dual chamber pacemakers in 70 patients (mean age 64.5), of whom 42 had AV block and 28 sick sinus syndrome, nine of them associated with AV block. Other cardiac disease coexistent with the conduction disturbance was present in 57% of the patients. Follow-up was conducted after implantation at first, 3rd, 6th month, and thereafter each 6 months. Mean follow-up was 20 +/- 14.3 months (2-72); of the 70 patients, 88% and 73% were followed at least for 6 and 12 months, respectively. Six patients (five had AV block) died 17 months on average after implantation. All patients but one had concomitant cardiac disease. Eleven patients (15.6%) presented complications, being all of them related to atrial channel: reprogramming to VVI in five (7%), mainly due to chronic atrial fibrillation (4 patients), whereas in the other one was secondary to loss of pacing and sensing functions; acute dislocation corrected with reoperation in 3 patients (4.3%); temporary loss of atrial sensing in 2 patients, and chronic in the last one, with change to DVI mode. Overall, considering deaths and changes to VVI mode, 15.6% of patients were not be able to maintain dual chamber pacing. In conclusion, our results show: 1) low rate of major complications; 2) good outcome of patients suffering from sick sinus syndrome; 3) the development of chronic atrial fibrillation was the main limitation of DDD pacing system.