Heart 1998;80:390-392 ( October )
Predictors of loss of atrioventricular synchrony in single lead VDD pacing
Division of Cardiology, University Hospital, Basel,
Switzerland
Correspondence to: Dr med Patrick Hunziker, Division of Cardiology, Kantonsspital, Petersgraben 4, 4031 Basel, Switzerland. email: HunzikerPA{at}ubaclu.unibas.ch
Accepted for publication 2 July 1998
Objective
To evaluate maintenance of proper
VDD function, defined as persistence of sinus rhythm with atrial
synchronous ventricular pacing, and to define factors predicting
failure of the VDD mode in patients with atrioventricular (AV) block
and normal sinus function.
DesignObservational study in 86 consecutive patients (mean (SD) age 74 (12) years; 38 women, 48 men)
with single lead VDD pacing systems (Intermedics Unity, n = 66,
Medtronic Thera VDD, n = 20), implanted for high degree AV block with
documented normal sinus node. Pacemaker function was assessed by event
counters, telemetric measurements, and Holter recordings. Demographic,
radiological, and pacing variables were correlated with loss of proper
VDD function.
ResultsDuring a mean (SD) follow up of 10 (10)
months (range 1-37), sinus rhythm and atrial triggered ventricular
pacing were maintained in 70 of 86 patients (81%). Atrial undersensing
was observed in nine patients, lead migration in two, atrial
fibrillation in three, and symptomatic sinus bradycardia in two.
Univariate predictors of loss of proper VDD function were: low position
of the atrial dipole relative to the carina (
6 cm; p < 0.01)
during fluoroscopy; and maximum programmable atrial sensitivity of the
pacemaker (p = 0.03). In a multivariate analysis, only dipole
position remained predictive of outcome (p < 0.02). Not predictive
were sex, age, symptoms before pacemaker implantation,
cardiothoracic ratio or dilatation of individual heart chambers on
chest x ray, side of device implant, and P wave amplitude
at implant.
ConclusionsTo maintain proper VDD function in the
long term, a low anatomical dipole position relative to the carina
should be avoided. Electrical guidance of dipole positioning does not
seem to influence long term outcome.
© 1998 by Heart
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