Long‐Term Follow‐Up of Patients Treated with VVI Pacing and Sequential Pacing with Special Reference to VA Retrograde Conduction

Abstract

The aim of this prospective study is comparing long-term prognosis in patients implanted with a VVI pacemaker (group A) with those implanted with a sequential pacing device, AAI or DDD, (group B). Both groups of 45 patients each, were comparable as regards to age, sex, pacing indications, underlying heart disease, and technical conditions of implantation and were followed-up over 55 months. Atrial arrhythmias (A.A.) incidence was higher in group A: 24.4% than group B: 8.8% (P less than 0.05). Arterial embolisms (A.E.) occurred in group A patients only. Worsening or occurrence of exercise limitation was more frequent in group A: 35.6% as compared to group B: 13.3% (P less than 0.05) and deaths related to these complications, occurred in seven cases in group A versus four cases in group B. In group A, all patients who experienced a worsening or occurrence of an A.A. or an A.E., had a ventriculoatrial conduction (VAC). No statistical difference was observed in worsening or occurrence of exercise limitation between patients with VAC and those without VAC: nine (42.8%) and seven (29.2%) but they respectively experienced at least one complication in 16 cases (76.2%) and seven cases (29.2%) (P less than 0.01). In conclusion, long-term prognosis in patients implanted with VVI pacing as compared to patients implanted with sequential pacing is poorer. The presence of VAC in patients treated with permanent VVI pacing is a major factor for complications and deaths related to A.E. and cardiac failure. Thus VVI pacing should be avoided in patients with VAC.

Heart Failure and Echocardiographic Changes During Long-term Follow-up of Patients With Sick Sinus Syndrome Randomized to Single-Chamber Atrial or Ventricular Pacing

“…In accordance with our results, one previous prospective, long-term follow-up study found no difference in the incidence of congestive heart failure during VVI pacing with and without retrograde conduction, respectively. 41 Therefore, no clear evidence exists that retrograde conduction causes heart failure. It might instead be the ventricular stimulation per se that is most important.…”

Practices and Outcome of Artificial Cardiac Pacing in 154 Dogs

“…36,37 This phenomenon occurs when the ventricular impulse traverses the AV node, causing retrograde depolarization of the atria and a subsequent reactivation of the ventricles. Results of this study revealed evidence of retrograde VA conduction in 3 dogs displaying atrial echo beats.…”

Predictors of atrial rhythm after atrioventricular node ablation for the treatment of paroxysmal atrial arrhythmias

“…16 25 Before ablation, patients with paroxysmal atrial arrhythmias are similar to patients with sick sinus syndrome with tachy-brady syndrome. Although postablation they are unlikely to have intact retrograde atrioventricular nodal conduction during ventricular pacing (which has been suggested as a further risk factor for developing chronic atrial fibrillation12), they will still experience the adverse haemodynamic consequences of loss of atrioventricular synchrony that possibly enhances the progression to chronic atrial fibrillation.…”