Key result
Pacemakers programmed to AAI resulted in a significantly lower ventricular pacing percentage at follow-up compared to DDD and VVI modes (8% vs 55% and 46%, respectively; P<0.001).
Why the study?
Does pacemaker programming mode affect ventricular pacing burden in patients with sinus node dysfunction and first-degree AV-block?
Observational (n=74)
No
Does pacemaker programming mode affect ventricular pacing burden in patients with sinus node dysfunction and first-degree AV-block?
Absolute Event Rate: 8% vs 55%
p-value: p=<0.001
In patients with sinus node dysfunction and first-degree AV-block, programming pacemakers to AAI mode significantly reduces ventricular pacing burden compared to DDD or VVI modes.
AAI mode was associated with lower ventricular pacing in sinus node dysfunction with first-degree AV block; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND: The optimal way of pacing in patients with an indication for pacing and concomitant first-degree atrioventricular (AV)-block is not known, and consequently, firm guidelines on this topic are lacking. This study explored the current pacemaker programming pattern in patients with first-degree AV-block who have a dual chamber pacemaker without cardiac resynchronization. METHODS: The study was a retrospective chart review conducted at Duke University Hospital. Patients receiving a pacemaker due to sinus node dysfunction with coexistent first-degree AV-block were studied. Baseline demographics and characteristics, as well as pacemaker programming parameters and follow-up data, were collected through chart review. Preimplantation and postimplantation electrocardiograms were analyzed. RESULTS: A total of 74 patients were included (mean age, 75 ± 11 y; 53% men). The mean ± SD preimplant PR interval and QRS duration was 243 ± 46 and 110 ± 30 milliseconds, respectively. A history of atrial fibrillation was present in 49% of the patients, and 77% had a normal left ventricular ejection fraction. The majority of patients (65%) had their pacemakers programmed to atrial pacing (AAI/DDD +/-R), whereas 32% and 2.7% of the pacemakers were programmed to AV-sequential pacing (DDD) and ventricular pacing (VVI), respectively. There were no significant differences in baseline characteristics or electrocardiogram measures between patients programmed to the 3 pacing modes. Patients with pacemakers programmed to AAI had a lower ventricular pacing percentage at follow-up (8 vs 55, and 46% [DDD and VVI, respectively]; P < .001). CONCLUSIONS: There was no evident association between baseline characteristics and programmed pacing mode in patients with first-degree AV-block. The choice of pacing mode affects long-term pacing burden, which in turn has been shown to influence outcome.
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Holmqvist et al. (2018) conducted an observational in Sinus node dysfunction with coexistent first-degree AV-block (n=74). AAI pacemaker programming vs. DDD or VVI pacemaker programming was evaluated on Ventricular pacing percentage at follow-up (p=<0.001). Pacemakers programmed to AAI resulted in a significantly lower ventricular pacing percentage at follow-up compared to DDD and VVI modes (8% vs 55% and 46%, respectively; P<0.001).
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