Mohammed Shurrab1, Yair Elitzur1, Jeff S Healey2, Lorne Gula3, Anna Kaoutskaia1, Carsten Israel4, Ching Lau1, Eugene Crystal5. 1. Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. 2. Arrhythmia Services, McMaster University, Hamilton, Ontario, Canada. 3. Arrhythmia Services, London Health Science Center, London, Ontario, Canada. 4. Ev. Krankenhaus Bethel, Bielefeld, Germany. 5. Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. Electronic address: eugene.crystal@sunnybrook.ca.
Abstract
BACKGROUND: Dual-chamber (DDD) and VDD pacing are recognized alternatives for patients with advanced atrioventricular (AV) conduction abnormalities and spared sinus node function. The comparative data between these 2 modes are limited. METHODS: A literature search was performed using multiple major databases. Outcomes of interest were (1) adverse events including incidence of atrial fibrillation (AF) and (2) procedural parameters. Odds ratio (OR) was reported for dichotomous variables and standardized mean difference (SMD) for continuous variables. RESULTS: Eight controlled studies (7 cohorts and 1 randomized controlled trial: total 1942 patients) were included. VDD mode was used in 922 patients. Mean follow-up period for the VDD group was 51 ± 24 months. There was a trend toward lower overall adverse events in the VDD group (9.6% vs 11.6%; OR, 0.74 [95% confidence interval (CI), 0.51-1.05; P = 0.09]). Shorter implantation and fluoroscopy times were noted with VDD pacing (46.2 ± 12 vs 65.9 ± 20 minutes; SMD, -0.96 [95% CI, -1.26 to -0.66; P < 0.0001] and 4.6 ± 1 vs 9.3 ± 0.4 minutes; SMD, -0.83 [95% CI, -1.38 to -0.29; P = 0.003], respectively). Mean P-wave amplitude was significantly lower in VDD (1.5 ± 0.8 mV vs 3.1 ± 0.9 mV; P = 0.02). The incidence of AF was lower in the VDD group but it did not reach statistical significance (7.5% vs 13.0%; OR, 0.7; 95% CI, 0.39-1.27; P = 0.24). CONCLUSIONS: This meta-analysis suggests that VDD is a reasonable alternative to DDD pacemakers with lower pneumothorax risk and shorter implantation and fluoroscopy times. More high-quality data are required to definitively compare the 2 strategies.
BACKGROUND: Dual-chamber (DDD) and VDD pacing are recognized alternatives for patients with advanced atrioventricular (AV) conduction abnormalities and spared sinus node function. The comparative data between these 2 modes are limited. METHODS: A literature search was performed using multiple major databases. Outcomes of interest were (1) adverse events including incidence of atrial fibrillation (AF) and (2) procedural parameters. Odds ratio (OR) was reported for dichotomous variables and standardized mean difference (SMD) for continuous variables. RESULTS: Eight controlled studies (7 cohorts and 1 randomized controlled trial: total 1942 patients) were included. VDD mode was used in 922 patients. Mean follow-up period for the VDD group was 51 ± 24 months. There was a trend toward lower overall adverse events in the VDD group (9.6% vs 11.6%; OR, 0.74 [95% confidence interval (CI), 0.51-1.05; P = 0.09]). Shorter implantation and fluoroscopy times were noted with VDD pacing (46.2 ± 12 vs 65.9 ± 20 minutes; SMD, -0.96 [95% CI, -1.26 to -0.66; P < 0.0001] and 4.6 ± 1 vs 9.3 ± 0.4 minutes; SMD, -0.83 [95% CI, -1.38 to -0.29; P = 0.003], respectively). Mean P-wave amplitude was significantly lower in VDD (1.5 ± 0.8 mV vs 3.1 ± 0.9 mV; P = 0.02). The incidence of AF was lower in the VDD group but it did not reach statistical significance (7.5% vs 13.0%; OR, 0.7; 95% CI, 0.39-1.27; P = 0.24). CONCLUSIONS: This meta-analysis suggests that VDD is a reasonable alternative to DDD pacemakers with lower pneumothorax risk and shorter implantation and fluoroscopy times. More high-quality data are required to definitively compare the 2 strategies.
Authors: Mohammed Shurrab; Amir Janmohamed; Jean-François Sarrazin; Felix Ayala-Paredes; Marcio Sturmer; Randall Williams; Satish Toal; Chris Lane; Kevin E Thorpe; Jeff S Healey; Eugene Crystal Journal: J Interv Card Electrophysiol Date: 2017-07-27 Impact factor: 1.900
Authors: Mohammed Shurrab; Teresa Pagacz; Ayelet Shauer; Ilan Lashevsky; David Newman; Eugene Crystal Journal: Clin Med Insights Cardiol Date: 2017-06-23
Authors: George Thomas; Daniel Y Choi; Harish Doppalapudi; Mark Richards; Sei Iwai; Emile G Daoud; Mahmoud Houmsse; Arvindh N Kanagasundram; Sumeet K Mainigi; Steven A Lubitz; Jim W Cheung Journal: J Cardiovasc Electrophysiol Date: 2019-08-05
Authors: Kelly Arps; Jonathan P Piccini; Rebecca Yapejian; Rhonda Leguire; Brenda Smith; Sana M Al-Khatib; Tristram D Bahnson; James P Daubert; Donald D Hegland; Kevin P Jackson; Larry R Jackson; Robert K Lewis; Sean D Pokorney; Albert Y Sun; Kevin L Thomas; Camille Frazier-Mills Journal: Heart Rhythm O2 Date: 2021-08-23