DDD(R)-pacing, but not AAI(R)-pacing induces left ventricular desynchronization in patients with sick sinus syndrome: tissue-Doppler and 3D echocardiographic evaluation in a randomized controlled comparison

Abstract

In patients with SSS, DDD(R)-pacing but not AAI(R)-pacing induces significant LV desynchronization and reduction of LVEF.

HRS/ACCF Expert Consensus Statement on Pacemaker Device and Mode Selection

“…In 50 patients with SND randomized to AAIR or DDDR pacing, dyssynchrony was more pronounced in the DDDR group than in the AAIR group at 12 months (p Ͻ0.05), reflecting a significant increase in dyssynchrony in the DDDR group without change in the AAIR group. Left ventricular ejection fraction decreased significantly in the DDDR group from baseline to 12 months (63.1 Ϯ 8% vs. 59.3 Ϯ 8%, p Ͻ0.05), while left ventricular ejection fraction remained unchanged in the AAIR group (61.5 Ϯ 11% vs. 62.3 Ϯ 7%, p ϭ NS), thus supporting the concept that some degree of ventricular pacing may promote structural remodeling in the ventricle (43).…”

The Effects of Right Ventricular Apical Pacing on Ventricular Function and Dyssynchrony

“…In addition, the posterior wall of the LV exhibited a delayed contraction, resulting in a significant delay between the activation of the septum (61 Ϯ 5 ms) and the posterior wall (116 Ϯ 18 ms) (40). More recently, these findings have been confirmed with dedicated echocardiographic techniques (41)(42)(43)(44). From these studies, it has become apparent that RV apical pacing can induce significant intraventricular mechanical dyssynchrony, which has been related to reduced LV function.…”

DDDR pacing results in left ventricular asynchrony with preservation of ejection fraction and NT-proBNP: A prospective study in sick sinus syndrome and normal ventricular function

“…Divergent results on BNP levels have been reported when DDD and AAI modes were compared [13,15,16]. These studies compared different pacing modes in different groups and not the effect of 2 pacing modes in the same group as was in our case.…”

“…We cannot exclude future changes in a prolonged follow-up. Asynchrony was induced by right ventricular pacing in patients with atrial fibrillation and preserved EF [12] and in patients with sick sinus syndrome [13]. The clinical meaning of dyssynchrony has not been elucidated [14].…”