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VDD vs DDD pacemakers: a meta-analysis
Mohammed Shurrab1, Yair Elitzur1, Jeff S Healey2
1Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Insights
Dual-chamber (DDD) and VDD pacing are alternatives for AV conduction issues. VDD pacing showed a trend toward fewer adverse events and significantly shorter procedure times compared to DDD pacing.
Area of Science:
- Cardiology
- Medical Devices
- Electrophysiology
Background:
- Dual-chamber (DDD) and VDD pacing are options for patients with advanced atrioventricular (AV) conduction abnormalities and preserved sinus node function.
- Limited comparative data exists between DDD and VDD pacing modes.
Purpose of the Study:
- To compare the safety and efficacy of VDD pacing versus DDD pacing.
- To analyze adverse events, including atrial fibrillation (AF) incidence, and procedural parameters.
Main Methods:
- A comprehensive literature search was conducted across major databases.
- Eight controlled studies (7 cohorts, 1 RCT; 1942 patients) were included in the meta-analysis.
- Outcomes assessed included adverse events (e.g., AF) and procedural parameters (implantation/fluoroscopy times).
Main Results:
- VDD pacing was associated with a trend toward lower overall adverse events (9.6% vs. 11.6%).
- Significantly shorter implantation (46.2 vs. 65.9 min) and fluoroscopy times (4.6 vs. 9.3 min) were observed with VDD pacing.
- The incidence of AF was lower in the VDD group (7.5% vs. 13.0%), though not statistically significant.
Conclusions:
- VDD pacing appears to be a viable alternative to DDD pacing.
- VDD pacing demonstrated reduced implantation and fluoroscopy times and a trend towards fewer adverse events.
- Further high-quality research is needed for definitive comparisons between VDD and DDD pacing strategies.
Background:
Dual-chamber (DDD) and VDD pacing are recognized alternatives for patients with advanced atrioventricular (AV) conduction abnormalities and spared sinus node function. The comparative data between these 2 modes are limited.
Methods:
A literature search was performed using multiple major databases. Outcomes of interest were (1) adverse events including incidence of atrial fibrillation (AF) and (2) procedural parameters. Odds ratio (OR) was reported for dichotomous variables and standardized mean difference (SMD) for continuous variables.
Results:
Eight controlled studies (7 cohorts and 1 randomized controlled trial: total 1942 patients) were included. VDD mode was used in 922 patients. Mean follow-up period for the VDD group was 51 ± 24 months. There was a trend toward lower overall adverse events in the VDD group (9.6% vs 11.6%; OR, 0.74 [95% confidence interval (CI), 0.51-1.05; P = 0.09]). Shorter implantation and fluoroscopy times were noted with VDD pacing (46.2 ± 12 vs 65.9 ± 20 minutes; SMD, -0.96 [95% CI, -1.26 to -0.66; P < 0.0001] and 4.6 ± 1 vs 9.3 ± 0.4 minutes; SMD, -0.83 [95% CI, -1.38 to -0.29; P = 0.003], respectively). Mean P-wave amplitude was significantly lower in VDD (1.5 ± 0.8 mV vs 3.1 ± 0.9 mV; P = 0.02). The incidence of AF was lower in the VDD group but it did not reach statistical significance (7.5% vs 13.0%; OR, 0.7; 95% CI, 0.39-1.27; P = 0.24).
Conclusions:
This meta-analysis suggests that VDD is a reasonable alternative to DDD pacemakers with lower pneumothorax risk and shorter implantation and fluoroscopy times. More high-quality data are required to definitively compare the 2 strategies.
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