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Current physiologic pacemakers: a serious problem with a new device.

J W Rubin, M J Frank, J P Boineau

    The American Journal of Cardiology
    |July 1, 1983
    PubMed
    Summary
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    DDD pacing with the Versatrax I pacemaker is often unsuitable due to pacemaker reentry tachycardia. This risk is higher in patients with normal AV conduction, leading to adverse neurologic and cardiovascular symptoms.

    Area of Science:

    • Cardiology
    • Biomedical Engineering
    • Electrophysiology

    Background:

    • Symptomatic bradyarrhythmias necessitate pacemaker implantation.
    • Dual-chamber (DDD) pacemakers aim to optimize cardiac function.
    • Pacemaker-induced tachycardia is a potential complication.

    Purpose of the Study:

    • To evaluate the efficacy and safety of DDD pacing using the Medtronic Versatrax I pacemaker.
    • To identify risk factors for pacemaker-induced tachycardia.
    • To assess the suitability of DDD pacing in patients with varying degrees of AV conduction.

    Main Methods:

    • Implantation of Medtronic Versatrax I (DDD) pacemakers in 20 adults.
    • Monitoring for optimal DDD pacing, tachycardia, and symptoms over 78 paced months.

    Related Experiment Videos

  • Analysis of ventriculoatrial (VA) conduction times and heart block presence.
  • Electrophysiologic studies and Holter monitoring for prediction of complications.

    • Main Results:

    • Only 9 of 20 patients maintained optimal DDD pacing.
    • Pacemaker reentry tachycardia occurred in 8 patients, leading to symptoms in 7.
    • Tachycardia risk was higher in patients with normal/near-normal AV conduction (7/12) compared to complete heart block (1/5).
    • Preimplantation studies and Holter monitoring did not reliably predict tachycardia.

    Conclusions:

    • The Versatrax I and similar pacemakers may be unsuitable for DDD pacing in many patients due to reentry tachycardia.
    • Slow retrograde VA conduction and short atrial refractory periods contribute to tachycardia risk.
    • Careful patient selection and monitoring are crucial for managing DDD pacing complications.