DDD versus VVIR Pacing in Patients, Ages 70 and Over, with Complete Heart Block

Background : Dual‐chamber pacing is believed to have an advantage over single‐chamber ventricular pacing. The aim of the study was to determine whether elderly patients with implanted pacemaker for complete atrioventricular block gain significant benefit from dual‐chamber (DDD) compared with single‐...

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Bibliographic Details
Published in:Pacing and clinical electrophysiology 2010-05, Vol.33 (5), p.583-589
Main Authors: OUALI, SANA, NEFFETI, ELYES, GHOUL, KARIMA, HAMMAS, SAMI, KACEM, SLIM, GRIBAA, RIM, REMEDI, FAHMI, BOUGHZELA, ESSIA
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
atrioventricular block
Biological and medical sciences
Cardiac dysrhythmias
Cardiac Pacing, Artificial - methods
Cardiology. Vascular system
Cross-Over Studies
DDD pacing
Diseases of the cardiovascular system
elderly
Female
Heart
Heart Block - diagnostic imaging
Heart Block - therapy
Humans
Male
Medical sciences
Pacemaker, Artificial
Prospective Studies
Quality of Life
Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)
Ultrasonography
VVI pacing
Walking
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Summary:Background : Dual‐chamber pacing is believed to have an advantage over single‐chamber ventricular pacing. The aim of the study was to determine whether elderly patients with implanted pacemaker for complete atrioventricular block gain significant benefit from dual‐chamber (DDD) compared with single‐chamber ventricular demand (VVIR). Methods: The study was designed as a double‐blind randomized two‐period crossover study—each pacing mode was maintained for 3 months. Thirty patients (eight men, mean age 76.5 ± 4.3 years) with implanted PM were submitted to a standard protocol, which included an interview, functional class assessment, quality of life (QoL) questionnaires, 6‐minute walk test, and transthoracic echocardiographic examinations. QoL was measured by the SF‐36. All these parameters were obtained on DDD mode pacing and VVIR mode pacing. Paired data were compared. Results : QoL was significantly different between the two groups and showed the best values in DDD. Overall, no patient preferred VVIR mode, 18 preferred DDD mode, and 12 expressed no preference. No differences in mean walking distances were observed between patients with single‐chamber and dual‐chamber pacing. VVI pacing elicited marked decrease in left ventricle ejection fraction and significant enlargement of the left atrium. DDD pacing resulted in significant increase of the peak systolic velocities in lateral mitral annulus and septal mitral annulus. Early diastolic velocities on both sides of mitral annulus did not change. Conclusion : In active elderly patients with complete heart block, DDD pacing is associated with improved quality of life and systolic ventricular function compared with VVI pacing. (PACE 2010; 583–589)
ISSN:0147-8389
1540-8159
DOI:10.1111/j.1540-8159.2009.02636.x