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Incidence and management of pacemaker-related complications during dual-chamber pacing
Insights
This study assessed pacemaker complications in 41 patients with complete heart block using DDD pacing. Most issues were minor and related to pacemaker programming, with few requiring reoperation.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Device Technology
Background:
- Complete heart block necessitates pacemaker implantation for survival.
- Atrioventricular (AV) universal pacing (DDD) is a common mode for managing heart block.
- Evaluating complication rates associated with DDD pacing is crucial for patient safety and device optimization.
Purpose of the Study:
- To evaluate the complication rate and clinical outcomes in patients with complete heart block undergoing DDD pacing.
- To identify specific issues related to DDD pacing mode and pacemaker hardware.
- To assess the impact of pacemaker programmability on complication management.
Main Methods:
- A prospective study of 41 consecutive patients with complete heart block.
- Follow-up duration of 2-30 months (mean 10.8 months).
- Utilized two pacemaker models: Cordis Sequicor Theta and Siemens-Elema 674.
Main Results:
- 12 out of 41 patients experienced clinical problems related to pacemaker treatment.
- Seven problems were ascribed to the DDD mode, with four resolved by reprogramming.
- Limitations were noted with a nonprogrammable atrial refractory period in one device, impacting endless loop tachycardia management.
Conclusions:
- DDD pacing is generally safe for complete heart block, with most complications being manageable through reprogramming.
- Pacemaker hardware limitations, such as nonprogrammable features, can pose challenges.
- Further research into optimizing DDD pacing parameters and device features is warranted.
Abstract:
To evaluate the complication rate during AV universal pacing (DDD), 41 consecutive patients with complete heart block were studied and followed up for 2-30 (mean 10.8) months. The Cordis Sequicor Theta was used in 6 patients and the Siemens-Elema 674 in 35. Clinical problems related to the pacemaker treatment occurred in 12 patients (pacemaker tachycardia triggered by retrograde atrial activation in 2, atrial oversensing in 3 and undersensing in 2, ventricular oversensing in 2 and undersensing in 1). Ventricular fibrillation occurred during threshold measurement in one patient. Seven of the problems could be ascribed to the DDD mode. Four of these 7 problems could be solved by reprogramming the pacemaker. A nonprogrammable atrial refractory period in the Cordis Sequicor was found to be a limitation in patients with endless loop tachycardia. In 3 cases reoperation had to be performed. In another 3 cases there were problems with ventricular sensing which in one could be solved by reprogramming. Apart from ventricular fibrillation, which could not be ascribed to the DDD mode, there were no serious problems in the clinical management of the patients.