(Circulation. 1996;94:578-583.)
© 1996 American Heart Association, Inc.
Articles |
Dual-Chamber Versus Ventricular Pacing
Critical Appraisal of Current Data
the Departments of Medicine and of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont (S.J.C., M.G., S.Y.) and the Department of Medicine, University of British Columbia, Vancouver, BC (C.K.), Canada.
Key Words: pacing • heart-assist device • electrical stimulation • pacemaker • stroke • survival
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Current Use of Dual-Chamber Pacing |
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Electrical stimulation of the heart to prevent bradycardia has been a practical treatment option for 40 years,1 and over this period pacemaker technology has advanced at a rapid rate. Many innovations in lead and generator technology have now become incorporated into standard practice and have made cardiac pacing very reliable and effective.2 Virtually all pacemakers implanted today use highly biocompatible materials and long-lasting lithium-based batteries; they are inhibited by spontaneously occurring cardiac activity and are multiprogrammable. Dual-chamber pacing more closely resembles the normal physiology of cardiac activation than does asynchronous ventricular stimulation because it maintains the usual synchrony of atrial and ventricular contraction and dominance of the sinus node. However, despite the theoretical advantages of dual-chamber pacing, this technology is not widely used in most countries. In a world survey of pacing done in 1989,3 dual-chamber pacemaker use varied between regions from 2% to 32% (median, 14%) of patients and was used in
30% of patients in 3 of 13 countries or regions surveyed.
Dual-chamber pacemaker use remains below expectations despite a statement in favor of dual-chamber pacing in guidelines for pacemaker implantation published jointly by the American Heart Association and the American College of Cardiology, which said "Although this may be less important at rapid rates, at slow rates it is almost always desirable to maintain AV synchrony. Long-term absence of AV synchrony increases the incidence of atrial fibrillation and stroke and may reduce patient life expectancy, particularly in patients with impaired left ventricular function, idiopathic hypertrophic subaortic stenosis
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