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Single-lead VDD pacing: long-term experience with four different systems
J L Rey1, C Tribouilloy, F Elghelbazouri
1Cardiology Department, University Hospital, Amiens, France.
Insights
Single-lead VDD pacing systems offer effective long-term atrial-triggered ventricular pacing for atrioventricular block. These systems demonstrate excellent atrioventricular synchronization, comparable to dual-lead DDD systems.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Devices
Background:
- Single-lead VDD pacing systems are used for atrioventricular block without sinus dysfunction.
- Previous studies focused on mid-term results from multicenter trials.
- Long-term data from a single center using various VDD systems were lacking.
Purpose of the Study:
- To evaluate the long-term efficacy of different single-lead VDD pacing systems.
- To assess atrioventricular synchronization in patients with atrioventricular block.
- To compare the performance of VDD systems with conventional DDD pacing.
Main Methods:
- A cohort of 150 patients (mean age 76 years) with atrioventricular block or hypertrophic cardiomyopathy received VDD pacing.
- Four different single-lead VDD systems were implanted.
- Atrioventricular synchronization was monitored using ECG and Holter monitoring during follow-up.
Main Results:
- Mean atrial electrogram amplitude was 2.01 mV, with no significant differences between systems.
- After a mean follow-up of 24 months, 95% of patients remained in VDD mode.
- 96% of patients with sinus rhythm achieved >90% atrioventricular synchronization, with 94% achieving >95%.
Conclusions:
- Single-lead VDD pacing systems provide satisfactory long-term atrioventricular synchronization.
- Performance is comparable to conventional dual-lead DDD pacing systems.
- These systems are a viable option for patients requiring ventricular pacing with atrial sensing.
Background:
Previous multicenter studies have shown that single-lead VDD pacing systems provide satisfactory atrial-triggered ventricular pacing at middle term for treatment of atrioventricular block without sinus dysfunction. However, we lack data on long-term results obtained with different VDD systems implanted in a large number of patients from a single center.
Methods:
One hundred fifty patients (76 +/- 11 years) with second- or third-degree atrioventricular block (n = 147) or symptomatic hypertrophic cardiomyopathy (n = 3) without sinus dysfunction were paced with four different VDD pacing systems able to sense the atrium and to pace the ventricle. Atrioventricular synchronization was assessed during follow-up by ECG and Holter monitoring.
Results:
Mean value of the atrial electrogram during implantation was 2.01 +/- 0.94 mV without any differences among the four systems. With a mean follow-up of 24 +/- 11 months, 95% of patients remain paced in VDD mode, whereas 5% have been reprogrammed in VVI or VVIR mode for permanent atrial fibrillation or loss of atrial sensing; 96% of patients with sinus atrium have atrioventricular synchronization >90% and 94% of patients have >95%, without significant difference between the four systems used.
Conclusions:
These different single-lead VDD systems can provide satisfactory long-term atrioventricular synchronization; results are comparable to those obtained with conventional DDD pacing systems with two leads.