AIM: Most patients with sick sinus syndrome (SSS) and normal atrioventricular (AV) conduction receive dual chamber (DDDR) pacemakers. Programming a long AV delay has been proposed to avoid ventricular pacing. The present study aimed to evaluate ventricular stimulation in SSS patients with DDDR pacemakers with a long AV delay. METHODS AND RESULTS: Thirty eight patients treated with DDDR pacemakers with a fixed long AV delay (300 ms) were studied. Data from the pacemaker event recorder were retrieved after 3 months and every year after implantation. Ten patients underwent 24 h Holter recording. Mean follow-up was 11.9 +/- 8.3 months. Median daily number of paced events in the ventricle was 2659 (25th-75th percentiles: 775-21 315) with a large inter-individual variation. The proportion of paced events in the ventricle correlated weakly with the baseline PQ interval (Spearman's rho 0.331, P = 0.043). In 12/38 patients the mean daily number of paced events in the ventricle exceeded 10,000. During 24 h Holter recording, pacemaker arrhythmias caused by repetitive retrograde atrioventricular conduction, known as VA (ventriculoatrial) conduction, occurred in five out of 10 patients. CONCLUSION: DDDR pacing with a fixed long AV delay is inefficient in reducing ventricular pacing in one third of patients and is associated with a high risk of arrhythmias caused by repetitive retrograde AV conduction, and therefore cannot be recommended for general use in SSS patients.
AIM: Most patients with sick sinus syndrome (SSS) and normal atrioventricular (AV) conduction receive dual chamber (DDDR) pacemakers. Programming a long AV delay has been proposed to avoid ventricular pacing. The present study aimed to evaluate ventricular stimulation in SSS patients with DDDR pacemakers with a long AV delay. METHODS AND RESULTS: Thirty eight patients treated with DDDR pacemakers with a fixed long AV delay (300 ms) were studied. Data from the pacemaker event recorder were retrieved after 3 months and every year after implantation. Ten patients underwent 24 h Holter recording. Mean follow-up was 11.9 +/- 8.3 months. Median daily number of paced events in the ventricle was 2659 (25th-75th percentiles: 775-21 315) with a large inter-individual variation. The proportion of paced events in the ventricle correlated weakly with the baseline PQ interval (Spearman's rho 0.331, P = 0.043). In 12/38 patients the mean daily number of paced events in the ventricle exceeded 10,000. During 24 h Holter recording, pacemaker arrhythmias caused by repetitive retrograde atrioventricular conduction, known as VA (ventriculoatrial) conduction, occurred in five out of 10 patients. CONCLUSION: DDDR pacing with a fixed long AV delay is inefficient in reducing ventricular pacing in one third of patients and is associated with a high risk of arrhythmias caused by repetitive retrograde AV conduction, and therefore cannot be recommended for general use in SSS patients.
Authors: Rick A Veasey; Anita Arya; Nick Freemantle; John Silberbauer; Nikhil R Patel; Guy W Lloyd; A Neil Sulke Journal: J Interv Card Electrophysiol Date: 2010-01-16 Impact factor: 1.900
Authors: Bernard Thibault; Anique Ducharme; Adrian Baranchuk; Marc Dubuc; Katia Dyrda; Peter G Guerra; Laurent Macle; Blandine Mondésert; Léna Rivard; Denis Roy; Mario Talajic; Jason Andrade; Rémi Nitzsché; Paul Khairy Journal: J Am Heart Assoc Date: 2015-07-23 Impact factor: 5.501