The relationship between right ventricular pacing and atrial fibrillation burden and disease progression in patients with paroxysmal atrial fibrillation: the long-MinVPACE study

Abstract

Right ventricular pacing induces increased AFB in patients with paroxysmal AF in the long term. Dual chamber MinVP algorithms result in reduced AFB and reduced disease progression from paroxysmal to persistent AF in the long term.

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

“…The detrimental effects of right ventricular pacing may be minimal in patients without significant structural heart disease but are likely amplified in patients with clinical heart failure, a high percentage of right ventricular apical pacing, and evidence of left ventricular systolic dysfunction. Minimizing right ventricular pacing may be achieved effectively by programming longer AV delays (e.g., 220 -250 ms) or implanting pacemakers that have specific algorithms for minimizing ventricular pacing (17,48). Such algorithms have been shown to substantially reduce the percentage of ventricular pacing in both patients with SND and AV block indications for pacing (49).…”

“…Such algorithms have been shown to substantially reduce the percentage of ventricular pacing in both patients with SND and AV block indications for pacing (49). Algorithms that reduce the cumulative percentage of ventricular pacing also have been reported to lower the burden of AF and the development of persistent AF during follow-up (13,48). In a retrospective study of 102 patients older than 75 years with SND, dual-chamber pacemakers with an algorithm to minimize ventricular pacing were associated with a fewer number of heart failure episodes and a lower risk of mortality than conventional dual-chamber devices (50).…”

Implanted Devices and Atrial Fibrillation

“…Moreover, nearly one third of all patients with complete atrioventricular (AV) block also shows tachy-brady syndrome. Right ventricular (RV) pacing has been demonstrated to increase the risk of developing AF in patients with permanent pacemaker implantation for both SND or AV block [4,5], because of its association with a number of pathophysiological changes which reduce left ventricular function and may promote AF. These changes include: an abnormal activation sequence (intraventricular and interventricular dyssynchrony), depressed left ventricular ejection fraction (EF), diastolic abnormalities and reduced myocardial perfusion [6].…”

Reducing Ventricular Pacing Frequency in Patients With Atrioventricular Block

“…Because the most common indication for permanent pacing is intermittent or persistent complete atrioventricular block (AVB) 7 (Web Table 3-ESC GDL 2013); the value of reducing VP has not been tested adequately in this patient group until recently (Table 1). [9][10][11][12][13][14][15][16][17][18][19][20][21][22] New studies have evaluated the use of an algorithm limiting the frequency of VP in patients with advanced or complete AVB (Table 1). The purpose of the present review is to report the recent apparently contradictory data suggesting more aggressively adopting algorithms that reduce the frequency of ventricular pacing in patients with AVB-a population for whom we have typically programmed continuous and uninterrupted ventricular pacing.…”