Key result
High rates of dual-chamber pacing (atrial pacing ≥48% combined with ventricular pacing >40%) were associated with an increased probability of ventricular tachyarrhythmias within 6 months.
Why the study?
Does the frequency of dual-chamber pacing increase the incidence of atrial and ventricular tachyarrhythmias in ICD recipients?
Cohort (n=141)
Yes
Does the frequency of dual-chamber pacing increase the incidence of atrial and ventricular tachyarrhythmias in ICD recipients?
High rates of dual-chamber pacing in ICD recipients are associated with an increased incidence of atrial and ventricular tachyarrhythmias within 6 months of implantation.
May support pacing minimization in ICD recipients; leaves open whether this reduces tachyarrhythmias in prospective trials.
Recent observations suggest that frequent dual-chamber pacing in recipients of implantable cardioverter defibrillators (ICD) may adversely influence clinical outcomes. This prospective, multicenter study examined the relationship between the frequency of atrial (%AP) and ventricular pacing (%VP) and the incidence of atrial (AT) and/or ventricular tachyarrhythmias (VT) in a standard ICD population. A total of 141 consecutive patients with primary and secondary ICD indications were studied. Continuous arrhythmia detection with a dual-chamber ICD revealed paroxysmal AT in 60 (43%) and VT in 72 (51%) patients within 6 months of device implantation. Far-field oversensing of ventricular signals occurred in 13% of all "atrial tachy response" mode switches. Without adjustment for covariates, a higher %AP was associated with an increased incidence of AT (P < 0.05). However, this association remained only weakly significant after adjustment for covariates using a multivariate model. High New York heart failure functional classes correlated significantly with AT (P = 0.02) and VT (P = 0.007). Rate-modulated pacing, programmed in 1/3 of patients, correlated with occurrence of AT (P = 0.006), but not with occurrence of VT. With respect to dual-chamber pacing, a %AP >/= 48% combined with a %VP > 40% was associated with an increased probability for VT. In conclusion, AT and VT occurred frequently within 6 months after dual-chamber ICD implantation. High rates of DDD/R stimulation were associated with a trend toward higher incidence of AT, VT, or both.
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Strohmer et al. (2005) conducted a cohort in Implantable cardioverter defibrillator (ICD) recipients (n=141). High frequency of atrial and ventricular pacing was evaluated on Incidence of atrial (AT) and/or ventricular tachyarrhythmias (VT) (p=< 0.05). High rates of dual-chamber pacing (atrial pacing ≥48% combined with ventricular pacing >40%) were associated with an increased probability of ventricular tachyarrhythmias within 6 months.
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