Importance of maintained atrio-ventricular synchrony in patients with pacemarkers

The effect of atrial contraction on cardiac function is reviewed in patients with dual chamber and rate-responsive ventricular pacemakers. The question posed was is there any haemodynamic, clinical or prognostic advantage of AV synchrony in dual chamber pacemakers in comparison to rate-responsive ventricular pacemakers? Optimal AV delay in dual chamber pacing favours cardiac performance at rest, while during exercise the increase in heart rate rather than AV synchrony influences cardiac performance and working capacity. However, there is little information on the benefit of maintained AV synchrony in patients' daily activities. Patients with pacemakers which maintain AV synchrony seem to have less morbidity and mortality than patients with ventricular stimulation alone, and there are comparable rates of complication in carriers of single and dual chamber pacemakers, the former showing problems with the pacemaker syndrome and the latter with atrial sensing and pacemaker-induced tachycardias. The disadvantage of dual chamber pacemakers are higher costs and time-consuming controls.