Indian Pacing Electrophysiol J. 2006 Jul 01;6(3):153-62.
Single-chamber versus dual-chamber implantable cardioverter defibrillators: do we need physiologic pacing in the course?.
Indian pacing and electrophysiology journal
Marco Budeus, Thomas Buck, Heinrich Wieneke, Raimund Erbel, Stefan Sack
PMID: 16943965
PMCID: PMC1513535
Abstract
BACKGROUND: Many patients with ICD receive different antiarrhythmic drugs (e.g. sotalol, amiodarone, beta-blockers) because of ventricular or atrial tachycardias. These drugs can cause AV-block or chronotropic incompetence resulting in a higher percentage of ventricular pacing.
METHODS: We analyzed in a retrospective study the impact of DDD(R) versus VVI(R) mode on subjective (NYHA classification) and objective parameters [brain natriuretic peptide (BNP), 6 minute walk test, echocardiography] in 12 of 120 patients (age 60.2 +/- 11.2 years; 10 males, 2 females) who needed an upgrading of a single to a dual chamber ICD. The ICD had to be upgraded because of chronotropic incompetence in all patients with signs of progressing heart failure. Data were collected in VVI(R)-pacing and after 6 and 12 months in DDD(R)-pacing with a long AV-interval and AV hysteresis to reduce ventricular pacing.
RESULTS: The 6 minute walk test (392.4 +/- 91.4 vs. 324.6 +/- 93.3 m, P < 0.001), NYHA-classification (1.4 +/- 0.3 vs. 2.6 +/- 0.8, P < 0.0001), BNP (234.1 +/- 73.5 vs. 410.4 +/- 297.0 pg/ml, P < 0.001), left ventricular ejection fraction (49.8 +/- 9.6 vs. 36.5 +/- 10.9 %, P < 0.0001) and A-wave (73.6 +/- 13.7 vs. 41.0 +/- 14.0 cm/sec, P < 0.0001) improved with DDD(R)-pacing after 12 months. The ventricular pacing decreased (84.2 +/- 18.1 vs. 1.1 +/- 1.7 %, P < 0.0001) after 12 months by DDD(R)-pacing with long AV-interval (220.0 +/- 10.4 ms) and AV hysteresis.
CONCLUSION: Our data show a superiority of DDD(R) mode versus VVI(R) mode regarding subjective and objective parameters as NYHA-classification, BNP, 6 minute walk test, left ventricular ejection fraction and left ventricular endsystolic volume after 12 months. The improvements seem to depend on the reduction of ventricular pacing with advanced atrial contraction. But only a small number of patients needed the upgradation.
References
- J Am Soc Echocardiogr. 1989 Sep-Oct;2(5):358-67 - PubMed
- Circulation. 2000 Mar 21;101(11):1297-302 - PubMed
- Circulation. 2002 Jul 9;106(2):233-8 - PubMed
- Am Heart J. 1994 Apr;127(4 Pt 2):1139-44 - PubMed
- J Am Coll Cardiol. 1994 Jul;24(1):225-32 - PubMed
- N Engl J Med. 2004 May 20;350(21):2151-8 - PubMed
- Circulation. 1999 Mar 23;99(11):1416-21 - PubMed
- N Engl J Med. 1997 Nov 27;337(22):1576-83 - PubMed
- Circulation. 2004 Dec 14;110(24):3646-54 - PubMed
- N Engl J Med. 1999 Jun 17;340(24):1855-62 - PubMed
- N Engl J Med. 2002 Mar 21;346(12):877-83 - PubMed
- Am J Cardiol. 1998 Sep 15;82(6):744-8 - PubMed
- Am Heart J. 1990 May;119(5):1077-83 - PubMed
- Am J Cardiol. 1996 Sep 12;78(5A):116-8 - PubMed
- J Am Coll Cardiol. 2001 Jun 15;37(8):2093-100 - PubMed
- Eur Heart J. 1998 May;19(5):808-16 - PubMed
- N Engl J Med. 1996 Dec 26;335(26):1933-40 - PubMed
- J Am Coll Cardiol. 1989 Mar 1;13(3):585-90 - PubMed
- Br Heart J. 1992 May;67(5):361-7 - PubMed
- J Am Coll Cardiol. 1989 Jun;13(7):1613-21 - PubMed
- Pacing Clin Electrophysiol. 1997 Jan;20(1 Pt 2):177-81 - PubMed
- Europace. 2002 Apr;4(2):143-7 - PubMed
- Circulation. 2003 Jun 17;107(23):2932-7 - PubMed
- Pacing Clin Electrophysiol. 1998 Apr;21(4 Pt 1):728-34 - PubMed
- Am J Cardiol. 1994 Feb 1;73(4):237-41 - PubMed
- JAMA. 2002 Dec 25;288(24):3115-23 - PubMed
- N Engl J Med. 2000 Feb 10;342(6):365-73 - PubMed
- Am Heart J. 1986 Jul;112(1):79-83 - PubMed
- J Am Coll Cardiol. 2004 Jan 7;43(1):39-43 - PubMed
- Eur Heart J. 1992 Jul;13(7):914-7 - PubMed
- Circulation. 1999 Oct 19;100(16):1714-21 - PubMed
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