Single-chamber Versus Dual-chamber Implantable Cardioverter Defibrillators: Do We Need Physiologic Pacing in The Course?
نویسندگان
چکیده
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.
منابع مشابه
Reduced risk for inappropriate implantable cardioverter-defibrillator shocks with dual-chamber therapy compared with single-chamber therapy: results of the randomized OPTION study.
OBJECTIVES The OPTION (Optimal Anti-Tachycardia Therapy in Implantable Cardioverter-Defibrillator Patients Without Pacing Indications) trial sought to compare long-term rates of inappropriate shocks, mortality, and morbidity between dual-chamber and single-chamber settings in implantable cardioverter-defibrillators (ICDs) patients. BACKGROUND The use of dual-chamber ICDs potentially allows be...
متن کاملInappropriate Shocks in Patients with ICDs: Single Chamber versus Dual Chamber
BACKGROUND Despite the technological evolution of the implantable defibrillator, one of the questions that remains is the possible benefit of the dual chamber versus single chamber implantable cardioverter defibrillator (ICD) in reducing inappropriate shocks. OBJECTIVE To evaluate which type of device provides fewer inappropriate shocks (dual chamber versus single chamber) in patients with im...
متن کاملComparison of Inappropriate Shocks and Other Health Outcomes Between Single‐ and Dual‐Chamber Implantable Cardioverter‐Defibrillators for Primary Prevention of Sudden Cardiac Death: Results From the Cardiovascular Research Network Longitudinal Study of Implantable Cardioverter‐Defibrillators
BACKGROUND In US clinical practice, many patients who undergo placement of an implantable cardioverter-defibrillator (ICD) for primary prevention of sudden cardiac death receive dual-chamber devices. The superiority of dual-chamber over single-chamber devices in reducing the risk of inappropriate ICD shocks in clinical practice has not been established. The objective of this study was to compar...
متن کاملComplications and Mortality of Single Versus Dual Chamber Implantable Cardioverter Defibrillators
BACKGROUND The implantable cardioverter defibrillators (ICDs) are increasingly being used as a treatment modality for life threatening tachyarrhythmia. The purpose of this study was to compare the frequency of complications and mortality between single-chamber and dual-chamber ICD implantation in Shahid Rajaie cardiovascular center. METHODS AND RESULTS Between January 2000 and December 2004, ...
متن کاملOutcomes of single- or dual-chamber implantable cardioverter defibrillator systems in Japanese patients
BACKGROUND There are no criteria for selecting single- or dual-chamber implantable cardioverter defibrillators (ICDs) in patients without a pacing indication. Recent reports showed no benefit of the dual-chamber system despite its preference in the United States. As data on ICD selection and respective outcomes in Japanese patients are scarce, we investigated trends regarding single- and dual-c...
متن کامل