Key result
Temporary VVI pacing is linked to ~237% more HF hospitalizations and reduced LVEF versus DDD pacing.
Why the study?
Short-term consequences of abrupt atrioventricular synchrony loss induced by temporary VVI/VVIR reprogramming in patients chronically adapted to DDD stimulation remain incompletely characterized.
Does temporary VVI/VVIR pacing increase heart failure hospitalizations and reduce LVEF in patients chronically adapted to DDD stimulation?
Does temporary VVI/VVIR pacing increase heart failure hospitalizations and reduce LVEF in patients chronically adapted to DDD stimulation?
Temporary loss of AV synchrony by reprogramming DDD pacemakers to VVI/VVIR causes rapid, severe, and only partially reversible clinical and echocardiographic deterioration, including increased HF hospitalizations.
Avoid temporary VVI in chronic DDD patients to limit HF risk; challenges assumptions of its safety and supports preserving AV synchrony.
Aims Temporary reprogramming of dual-chamber (DDD) pacemakers to non-synchronous ventricular modes (VVI/VVIR) may be required in selected clinical scenarios, but short-term consequences of abrupt atrioventricular (AV) synchrony loss remain incompletely characterized. Leveraging a unique natural experiment, this study aimed to quantify the clinical and echocardiographic consequences of temporary VVI/VVIR pacing in patients in sinus rhythm chronically adapted to DDD stimulation. Methods and results In this prospective observational study, 93 patients (79.9±16.0 years; 63.4% AV block) with recalled DDD pacemakers were reprogrammed to VVI/VVIR for 6 months, followed by DDD restoration. Serial assessments included echocardiography, BNP, and 6-minute walk test. Primary endpoints were changes in left ventricular ejection fraction (LVEF) and heart failure (HF) hospitalizations; secondary endpoints included echocardiographic remodelling parameters, functional capacity, quality of life, and atrial fibrillation. Clinical events were tracked for 12 months. Ventricular pacing remained >88% throughout. During the VVI/VVIR period, HF hospitalizations increased compared with the subsequent DDD restoration period (22.6% vs 6.7%, p<0.001). This was accompanied by adverse echocardiographic remodelling, a decline in LVEF from 57.3% to 53.0% (p<0.001), and a marked BNP increase from 155 to 260 pg/ml (p<0.001). After DDD restoration, clinical and structural recovery was incomplete: LVEF improved to 54.8% and BNP decreased to 210 pg/ml, but both remained significantly worse than baseline (p<0.05). Conclusion Temporary loss of AV synchrony in chronically DDD-paced patients was associated with rapid, severe, and only partially reversible clinical and echocardiographic deterioration. These findings underscore that continuous AV synchrony is a critical determinant of clinical stability.
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Martignani et al. (2026) studied this question. Temporary VVI pacing in chronically DDD-paced patients increased heart failure hospitalizations (22.6% vs 6.7%) and reduced LVEF (57.3% to 53.0%), with only partial recovery upon DDD restoration.
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