Comparative survival after permanent ventricular and dual chamber pacing for patients with chronic high degree atrioventricular block with and without preexistent congestive heart failure

Alpert, Martin A.; Curtis, Jennifer; Sanfelippo, John F.; Flaker, Greg C.; Walls, Joseph T.; Mukerji, Vaskar; Villarreal, Daniel; Katti, S. K.; Madigan, Niall P.; Król, Ryszard B.

doi:10.1016/s0735-1097(86)80358-8

Cited by 110 publications

(18 citation statements)

References 26 publications

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“…Untreated complete heart block has a one year and five year mortality of 50% and 75%–90% respectively11 12; while survival is 70%–85% at five years in those paced 12…”

Section: Discussionmentioning

confidence: 99%

Permanent pacemaker insertion in a district general hospital: indications, patient characteristics, and complications

Eltrafi

Currie

Silas

2000

Postgraduate Medical Journal

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This report reviews the experience of permanent pacemaker insertion in a district general hospital (catchment population of 350 000) and makes a comparison with the national database and other hospitals in the UK. Methods-The records of all patients receiving a permanent pacemaker in the inclusive period January 1996 to December 1998 were reviewed. Data collected included number of patients paced each year, age, sex, indications, and complications. Results-In the three years reviewed 200 patients received new permanent pacemakers, a rate of 190 per million population per year, which is similar to the national implantation rate of permanent pacemakers but lower than that of most European countries (see discussion). The majority of patients paced were elderly (75% were above the age of 70 years).Atrioventricular block (including complete heart block, 45%, and Mobitz type 2 block, 12.5%) was the commonest indication for permanent pacemaker insertion, followed by sick sinus syndrome (25%) and these findings are comparable to those reported previously. However, carotid sinus syndrome was responsible for 16% of the patients paced and this was higher than that reported in the national database (6.5%). Only 1% of the pacemaker modes used was inappropriate and the complication rate was low at 3%. Conclusions-This report confirms that permanent pacemaker insertion can be eVectively and safely provided locally for the increasingly ageing population. The implantation rate both locally and nationally is still much lower than that of some countries in Europe. (Postgrad Med J 2000;76:337-339) Keywords: permanent pacemaker; atrioventricular block; sick sinus syndrome; carotid sinus syndromeIn 1987 the working group of the British Cardiac Society endorsed the view that permanent cardiac pacing can be eVectively performed in district general hospitals 1 ; by 1992 one third of hospitals in the UK provided this service.2 This is becoming more important nowadays as the number of elderly patients is increasing and it is more convenient for this service to be provided locally. In this study a three year experience of a district general hospital serving a population of 350 000 is reported.The aim of this study was to report a district general hospital experience in performing permanent pacemaker insertion and to compare it with that reported from a similar population and that of the national database. MethodsThe records of the patients who had had permanent pacemakers in the inclusive period of January 1996 to December 1998 were reviewed.The permanent pacemaker insertion was performed in the cardiac catheter laboratory by one of two teams: each comprised a consultant cardiologist, a specialist registrar, a cardiac technician, a cardiac nurse, and a radiographer.Prophylactic antibiotics (flucloxacillin 1 g or clindamycin 600 mg) were given intravenously routinely before permanent pacemaker insertion and continued orally (fluocloxacillin 500 mg four times a day or clindamycin 300 mg four times a day) for 48 hours afterwards. T...

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“…Untreated complete heart block has a one year and five year mortality of 50% and 75%–90% respectively11 12; while survival is 70%–85% at five years in those paced 12…”

Section: Discussionmentioning

confidence: 99%

Permanent pacemaker insertion in a district general hospital: indications, patient characteristics, and complications

Eltrafi

Currie

Silas

2000

Postgraduate Medical Journal

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“…In patients with sinus node disease, maintaining atrioventricular synchrony lowers the risk of atrial fibrillation, heart failure, stroke and mortality during long term follow-up, as demonstrated in both retrospective studies [3,4] and in a randomized prospective study [5] . In high-grade atrioventricular block data are limited, but suggest a survival benefit in patients with heart failure [6,7] . These data emanate from studies comparing different pacing modes at primary pacemaker implantation, and the results may not be applicable to an upgrade from long-term ventricular stimulation.…”

Section: Introductionmentioning

confidence: 99%

Improved cardiac function and quality of life following upgrade to dual chamber pacing after long-term ventricular stimulation

Höijer

Brandt

Willenheimer³

et al. 2002

European Heart Journal

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Aims Many patients with sinus node disease or atrioventricular block have previously received pacemakers with only ventricular stimulation (VVI or VVIR). This study aimed to investigate whether quality of life and cardiac function were affected by an upgrade to dual chamber pacing (DDDR or DDIR) following long-term ventricular stimulation.Methods After implantation of an atrial lead and a DDDR pulse generator, a randomized, double-blind crossover study was performed in 19 patients, previously treated with ventricular pacing for a median time of 6·8 years. Patients were randomized to 8 weeks with either VVIR or DDDR/ DDIR pacing; after this time, the other mode was programmed for 8 weeks. At the end of each period, the patients' quality of life was evaluated and echocardiography was performed together with Holter monitoring and blood samples for brain natriuretic peptide.Results Sixteen of the patients preferred DDDR and two VVIR pacing (P=0·001); one was undecided. Seven patients demanded an early crossover while paced in the VVIR mode, vs none in the DDDR mode (P=0·008). Quality of life was higher in the DDDR mode in 11 of 17 modalities, reaching statistical significance for dyspnoea (P<0·05) and general activity (P<0·05). Echocardiography showed significantly larger left ventricular end-diastolic dimensions in the DDDR mode (P=0·01), whereas end-systolic dimensions did not differ. Left ventricular systolic function was significantly superior in the DDDR mode (mean aortic velocity-time integral: P<0·001) and left atrial diameter was significantly smaller in the DDDR mode (P=0·01). The plasma level of brain natriuretic peptide was significantly lower in DDDR mode (P=0·002).Conclusion An upgrade to dual chamber rate adaptive pacing results in significantly improved quality of life and cardiac function as compared to continued VVIR stimulation and should thus be considered in patients with ventricular pacemakers who have not developed permanent atrial fibrillation or flutter.

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“…There is, however, some evidence that patient outcome might be improved, at least in a subgroup of patients with impaired left ventricular function [2,3] . During exercise, cardiac output is increased by dual-chamber pacing [4] .…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of dual-chamber pacemaker therapy: does single lead VDD pacing reduce treatment costs of atrioventricular block?

Wiegand

Potratz²,

Bode³

et al. 2001

European Heart Journal

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Comparative survival after permanent ventricular and dual chamber pacing for patients with chronic high degree atrioventricular block with and without preexistent congestive heart failure

Cited by 110 publications

References 26 publications

Permanent pacemaker insertion in a district general hospital: indications, patient characteristics, and complications

Permanent pacemaker insertion in a district general hospital: indications, patient characteristics, and complications

Improved cardiac function and quality of life following upgrade to dual chamber pacing after long-term ventricular stimulation

Cost-effectiveness of dual-chamber pacemaker therapy: does single lead VDD pacing reduce treatment costs of atrioventricular block?

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