Abstract 14148: VDD Pacing in Atrio-Ventricular Nodal(AVN) Block - An Overlooked Alternative to DDD Pacing
Introduction: VDD pacing can be used as an alternative to DDD in patients (Pts) with AVN block with preserved sinus node (SN) function. VDD pacing offers the advantages of lower costs, shorter implantation times, lower radiation exposure and lower rates of pneumothorax. However, VDD pacing is used less often than DDD due to concerns regarding the loss of atrial sensing.
Methods: Grey Nuns Hospital is an academic hospital serving Northern Alberta, Northern British Columbia and the North-West Territories. Data was collected prospectively in a database. Pts with AVN block and no history of previous SN dysfunction or recurrent atrial fibrillation were selected for VDD pacing. Only patients with a minimum follow-up period of 1 year were included in the study to capture all early failures.
Results: Between 1990-2014, 316 VDD pacemakers were implanted. Follow-up data was not available for 33 patients (10.4%) due to moving out of province/country, thus data from 283 Pts were analyzed. The average follow-up duration was 5.9 ± 0.3 yrs (SEM) amounting to a total of 1680.5 Pt-Yrs. Death occurred in 99 patients, with a mean duration to death of 4.7 ± 0.4 yrs. There were no deaths due to complications of the implantation. Reprogramming to VVIR was done in 47 Pts (16.6%): Due to atrial fibrillation in 21 (7.4%); Atrial malsensing in 26 (9.2%) - 1 event per 64.6 Pt-Yrs. Eight (2.8%) of the malsensing events occurred within 3 months of implantation and 4(1.4%) between 3-12 months. Of the 26 Pts, 1(0.4%) required implantation of a new atrial lead due to the development of Pacemaker Syndrome.
Conclusions: This study demonstrated VDD pacing to be a viable alternative to DDD pacing in patients with AVN block and intact SN function. The rate of reprogramming to VVIR due to atrial malsensing was low, at 1 event per 64.6 Pt-Yrs. Although 7.4% required a change to VVIR due to atrial fibrillation, these events would likely have occurred at a similar rate even with DDD pacing. The 4.2% atrial malsensing rate within 1 year of implantation compares favorably with a reported 3-4% rate of atrial lead malfunction/dislodgement associated with atrial lead implantation. Furthermore, atrial lead dislodgment may necessitate re-opening of the pocket for re-positioning with a concomitant increased risk of infection.
Author Disclosures: K.S. Samarasinghe: None. U. Chhetri: None. D. Beaudette: None. A. Sander: None. D. Sawyer: None. D. Moir: None. S. Gulamhusein: None. M. Hanninen: None. M. Senaratne: None.
- © 2016 by American Heart Association, Inc.