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Observational Study
. 2016 Aug;95(35):e4668.
doi: 10.1097/MD.0000000000004668.

Long-term outcome in patients receiving permanent pacemaker implantation for atrioventricular block: Comparison of VDD and DDD pacing

Jo-Nan Liao  1 , Tze-Fan Chao, Ta-Chuan Tuan, Chi-Woon Kong, Shih-Ann Chen
Affiliations
Observational Study

Long-term outcome in patients receiving permanent pacemaker implantation for atrioventricular block: Comparison of VDD and DDD pacing

Jo-Nan Liao et al. Medicine (Baltimore). 2016 Aug.

Abstract

A permanent pacemaker (PPM) with dual chamber pacing (DDD) offers atrioventricular synchronization for patients with atrioventricular block (AVB). Single lead atrial synchronous ventricular pacing mode (VDD) is an alternative, but there are concerns about its efficacy and risk of atrial undersensing. Whether VDD can be a good alternative in patients with AVB remains unknown. The aim of the present study was to compare the long-term risk of mortality of VDD with DDD pacing.A total of 207 patients undergoing PPM implantations for AVB with VDD mode were enrolled from 2000 to 2013. Another 828 age- and sex-matched patients undergoing DDD implantations during the same period of time were selected as the control group in a 1 to 4 ratio. The study endpoint was mortality.A total of 1035 patients (64.3% male) were followed up for 46.5 ± 43.2 months. The mean ages were 75.0 years for VDD, and 74.9 years for DDD. The Kaplan-Meier survival analysis showed no significant difference in long-term survival between the VDD and DDD groups (log-rank P = 0.313). After adjustment for baseline characteristics, the VDD and DDD groups had a similar long-term prognosis with an adjusted hazard ratio of 0.875 (P = 0.445). Further analyses for the risk of cardiovascular and noncardiovascular deaths also showed no significant differences between the 2 groups.The long-term prognosis of VDD mode is comparable to that of DDD mode. Single lead VDD can be considered as an alternative choice in patients with AVB without sinus nodal dysfunction.

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Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flow diagram of study enrolment. From 2000 to 2013, a total of 207 patients with AVB undergoing PPM implantation with VDD mode were identified. Another 828 age- and sex-matched patients with AVB undergoing DDD mode implantation during the same period of time were selected as the control group at a 1 to 4 ratio. AVB = atrioventricular block, DDD = dual chamber pacing, PPM = permanent pacemaker, VDD = single lead atrial synchronous ventricular pacing mode.
Figure 2
Figure 2
Cumulative risk of mortality of patients with AVB undergoing VDD or DDD implantations. During the follow-up, the risk of mortality did not differ significantly between the VDD and DDD groups. AVB = atrioventricular block, DDD = dual chamber pacing, VDD = single lead atrial synchronous ventricular pacing mode.
Figure 3
Figure 3
Cumulative risk of cardiovascular (A) and noncardiovascular (B) deaths of patients with AVB undergoing VDD or DDD implantation. The risks of cardiovascular (A) and noncardiovascular (B) deaths were similar between the 2 groups. AVB = atrioventricular block, DDD = dual chamber pacing, VDD = single lead atrial synchronous ventricular pacing mode.
Figure 4
Figure 4
Pacing mode (VDD or DDD) and mortality risk in different subgroups of patients. The pacing mode, either VDD or DDD, did not significantly influence long-term prognosis in different groups of patients. Systemic diseases represent the presence of hypertension, diabetes mellitus, heart failure, end-stage renal disease, coronary artery disease, or myocardial infarction. DDD = dual chamber pacing, VDD = single lead atrial synchronous ventricular pacing mode
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References

    1. Epstein AE, DiMarco JP, Ellenbogen KA, et al. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation 2013; 127:e283–e352. - PubMed
    1. Mond HG, Irwin M, Ector H, et al. The world survey of cardiac pacing and cardioverter-defibrillators: calendar year 2005 an International Cardiac Pacing and Electrophysiology Society (ICPES) project. Pacing Clin Electrophysiol 2008; 31:1202–1212. - PubMed
    1. Proclemer A, Ghidina M, Gregori D, et al. Trend of the main clinical characteristics and pacing modality in patients treated by pacemaker: data from the Italian Pacemaker Registry for the quinquennium 2003-07. Europace 2010; 12:202–209. - PubMed
    1. Santini M, Ricci R, Pignalberi C, et al. Immediate and long-term atrial sensing stability in single-lead VDD pacing depends on right atrial dimensions. Europace 2001; 3:324–331. - PubMed
    1. Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation 2008; 117:e350–e408. - PubMed

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