Longevity in Patients With High Degree Atrioventricular Block Paced in the Atrial Synchronous or the Fixed Rate Ventricular Inhibited Mode

Abstract

Survival in patients paced for high degree AV block has been demonstrated to be influenced by underlying cardiac disease in particular congestive heart failure. One previous study has suggested that dual chamber pacing may improve the vital prognosis for such patients. To investigate this, 74 patients treated with rate adaptive atrial synchronous (VDD) and 74 patients treated with VVI pacemakers for high degree AV block, were retrospectively studied for a mean of 5.4 years by life-table analysis. The two groups had an equal distribution of age, sex, date of pacemaker implantation, and concomitant cardiovascular diseases. Total mortality and estimated survival did not differ between the two groups. The estimated survival in the VDD group at 1, 3, and 5 years for patients without and with congestive heart failure was 94%, 86% and 78%, and 92%, 83% and 72%, respectively. In the VVI group the corresponding values were 95%, 90%, and 83% for patients without congestive heart failure and 82%, 64%, and 47% for those with congestive heart failure (P = 0.008). Compared to the expected survival rate of the general Swedish population, only the VVI group with congestive heart failure, had an excess mortality (P = 0.007). Patients with high degree AV block have a fairly normal vital prognosis irrespective of pacing mode. The prognosis for patients with congestive heart failure was negatively affected by VVI pacing. Thus, for patients with congestive heart failure the choice of pacing mode is of vital importance, whereas for patients without congestive heart failure, other factors such as feeling of well-being and exercise capacity should decide the final choice of pacing mode.

Long-term survival after pacemaker implantation Prognostic importance of gender and baseline patient characteristics

“…Despite its widespread use, overall longterm survival of pacemaker patients has been addressed by only few studies during the last three decades. [5][6][7][8][9][10] Most studies focused on differences between AAI, VVI and DDD pacing in sick-sinus syndrome or AV-block, [11][12][13][14][15][16][17] and few studies evaluated differences in survival in a general pacemaker population 2,3,6-9,12,14,18-20 or in elderly patients. [21][22][23] In this study, we evaluated the survival of 6505 patients after pacemaker implantation from 1971 until 2000 with the aim of identifying prognostic factors.…”

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

“…Small, randomized crossover studies have reported significant differences in quality of life, with most individual patients preferring dual-chamber to single-chamber pacing (Table 3) (31,(67)(68)(69)(70)(71)(72)(73)(74)(75)(76)(77)(78)(79)(80)(81)(82)(83)(84). These studies included patients who were capable of exercising, and many had been paced in the dualchamber mode at the time of study enrollment.…”

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

“…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] .…”