VDD pacemaker: An effective and reliable physiological pacing modality in elderly patients.

Area of Science:

• Cardiology
• Geriatrics
• Biomedical Engineering

Background:

• Single chamber pacing is an option for elderly patients.
• VDD pacemakers offer physiological pacing by preserving atrial sensing, superior to VVI devices for patients in sinus rhythm.
• This study investigates the long-term efficacy of VDD pacemakers in elderly individuals diagnosed with atrioventricular block.

Purpose of the Study:

• To assess the long-term performance and reliability of VDD pacemakers in elderly patients (≥75 years) with atrioventricular block.
• To evaluate the rate of mode switching from VDD to VVIR pacing and identify associated factors.
• To analyze the impact of atrial sensing loss on mortality and the incidence of new-onset atrial fibrillation.

Main Methods:

• A retrospective observational study included 200 elderly patients (≥75 years) with atrioventricular block and normal sinus rhythm.
• Patients received VDD pacemaker implantation between 2016 and 2018.
• A 3-year follow-up (FUP) was conducted to analyze clinical characteristics, implantation complications, and pacing mode maintenance.

Main Results:

• After 3-year FUP, 90.5% of patients maintained VDD pacing; 9.5% switched to VVIR due to P-wave undersensing or permanent atrial fibrillation.
• Lower baseline P-wave amplitude was associated with mode switching.
• Atrial sensing loss during FUP was linked to a higher incidence of de novo atrial fibrillation (31.6% vs. 12.7%) but showed no correlation with all-cause, cardiovascular, or non-cardiovascular mortality.

Conclusions:

• VDD pacing is a dependable long-term pacing strategy for elderly patients with atrioventricular block.
• The majority of elderly patients successfully maintain VDD pacing with adequate atrial sensing.
• While atrial sensing loss may increase the risk of new atrial fibrillation, it does not appear to impact long-term mortality in this population.