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[The DDD pacemaker implanted intravenously]
V Araya Gómez1, L López Barreiro, J A González-Hermosillo
1Departamento de Electrofisiología Clínica, Instituto Nacional de Cardiología Ignacio Chávez, México, D.F.
Insights
Dual chamber (DDD) pacemakers are effective for heart rhythm issues like AV block. However, implantation requires expertise, and 17% of patients experienced complications, often necessitating pacing mode changes.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Dual chamber pacing (DDD) is a common therapy for bradyarrhythmias.
- Understanding implantation techniques and complication rates is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the outcomes and complications of intravenous DDD pacemaker implantation.
- To identify factors associated with complications in DDD pacemaker recipients.
Main Methods:
- Retrospective study of 66 patients receiving DDD pacemakers.
- Analysis of implantation routes (subclavian punction vs. cephalic vein dissection).
- Assessment of complications, pacing parameters, and follow-up data over a mean of 16 months.
Main Results:
- 17% of patients experienced complications, with 9 requiring a change in pacing mode.
- Complications included loss of atrial/ventricular capture, pacemaker-mediated tachycardia, infection, and atrial fibrillation.
- Lower P wave amplitude and higher atrial pacing thresholds at implantation were associated with higher complication rates (p < 0.005).
Conclusions:
- DDD pacing is a well-established therapy but demands meticulous implantation and specialized follow-up.
- Pre-implantation pacing parameters may predict the risk of complications.
- Optimizing implantation techniques and patient selection can potentially reduce adverse events.
Abstract:
Retrospectively, we studied 66 consecutive patients in whom we implanted an intravenous DDD pacemaker. The indications were: AV block in 52 patients (79%), sick sinus syndrome in 5 patients (7.5%), both AV block and sick sinus syndrome in 4 patients (6%), and other causes in 5 (7.5%). The venous access route was by subclavian punction in 38 cases (57.5%) and by cephalic vein dissection in 28 (42.5%). With a mean follow-up of 16 months, there were complications in 11 patients (17%), in 9 of them, it was necessary a change in pacing mode different to DDD, and was possible to maintain a DDD pacing mode in 2 patients with a minimal reprogramming. The complications were: A) lost of sense and/or atrial capture in 10 patients (3 of them, had also loss of ventricular capture, one had pacemaker-mediated tachycardia, other had diaphragmatic stimulation and other had a severe infection of the pocket), B) atrial fibrillation appeared in another patient. At the implantation time there were significant differences between patients with and without complications on follow-up, the P wave amplitude was 1.86 +/- 0.75 mV in the first group vs. 3.06 +/- 1.52 mV in the latter group, p < 0.005, and the atrial pacing threshold was 1.10 +/- 1.17 microJ in the first group vs. 0.65 +/- 0.66 microJ in the latter group, p < 0.005. We consider that dual chamber stimulation is a well established form of therapy, although, it requires a more laborious implantation and specialized personal for its follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)