Cargando…
Single-chamber Versus Dual-chamber Implantable Cardioverter Defibrillators: Do We Need Physiologic Pacing in The Course?
BACKGROUND: Many patients with ICD receive different antiarrhythmic drugs (e.g. sotalol, amiodarone, β-blockers) because of ventricular or atrial tachycardias. These drugs can cause AV-block or chronotropic incompetence resulting in a higher percentage of ventricular pacing. METHODS: We analyzed in...
Autores principales: | , , , , |
---|---|
Formato: | Texto |
Lenguaje: | English |
Publicado: |
Indian Pacing and Electrophysiology Group
2006
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1513535/ https://www.ncbi.nlm.nih.gov/pubmed/16943965 |
_version_ | 1782128499993083904 |
---|---|
author | Budeus, Marco Buck, Thomas Wieneke, Heinrich Erbel, Raimund Sack, Stefan |
author_facet | Budeus, Marco Buck, Thomas Wieneke, Heinrich Erbel, Raimund Sack, Stefan |
author_sort | Budeus, Marco |
collection | PubMed |
description | BACKGROUND: Many patients with ICD receive different antiarrhythmic drugs (e.g. sotalol, amiodarone, β-blockers) because of ventricular or atrial tachycardias. These drugs can cause AV-block or chronotropic incompetence resulting in a higher percentage of ventricular pacing. METHODS: We analyzed in a retrospective study the impact of DDD(R) versus VVI(R) mode on subjective (NYHA classification) and objective parameters [brain natriuretic peptide (BNP), 6 minute walk test, echocardiography] in 12 of 120 patients (age 60.2 ± 11.2 years; 10 males, 2 females) who needed an upgrading of a single to a dual chamber ICD. The ICD had to be upgraded because of chronotropic incompetence in all patients with signs of progressing heart failure. Data were collected in VVI(R)-pacing and after 6 and 12 months in DDD(R)-pacing with a long AV-interval and AV hysteresis to reduce ventricular pacing. RESULTS: The 6 minute walk test (392.4 ± 91.4 vs. 324.6 ± 93.3 m, P < 0.001), NYHA-classification (1.4 ± 0.3 vs. 2.6 ± 0.8, P < 0.0001), BNP (234.1 ± 73.5 vs. 410.4 ± 297.0 pg/ml, P < 0.001), left ventricular ejection fraction (49.8 ± 9.6 vs. 36.5 ± 10.9 %, P < 0.0001) and A-wave (73.6 ± 13.7 vs. 41.0 ± 14.0 cm/sec, P < 0.0001) improved with DDD(R)-pacing after 12 months. The ventricular pacing decreased (84.2 ± 18.1 vs. 1.1 ± 1.7 %, P < 0.0001) after 12 months by DDD(R)-pacing with long AV-interval (220.0 ± 10.4 ms) and AV hysteresis. CONCLUSION: Our data show a superiority of DDD(R) mode versus VVI(R) mode regarding subjective and objective parameters as NYHA-classification, BNP, 6 minute walk test, left ventricular ejection fraction and left ventricular endsystolic volume after 12 months. The improvements seem to depend on the reduction of ventricular pacing with advanced atrial contraction. But only a small number of patients needed the upgradation. |
format | Text |
id | pubmed-1513535 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2006 |
publisher | Indian Pacing and Electrophysiology Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-15135352006-08-29 Single-chamber Versus Dual-chamber Implantable Cardioverter Defibrillators: Do We Need Physiologic Pacing in The Course? Budeus, Marco Buck, Thomas Wieneke, Heinrich Erbel, Raimund Sack, Stefan Indian Pacing Electrophysiol J Original Article BACKGROUND: Many patients with ICD receive different antiarrhythmic drugs (e.g. sotalol, amiodarone, β-blockers) because of ventricular or atrial tachycardias. These drugs can cause AV-block or chronotropic incompetence resulting in a higher percentage of ventricular pacing. METHODS: We analyzed in a retrospective study the impact of DDD(R) versus VVI(R) mode on subjective (NYHA classification) and objective parameters [brain natriuretic peptide (BNP), 6 minute walk test, echocardiography] in 12 of 120 patients (age 60.2 ± 11.2 years; 10 males, 2 females) who needed an upgrading of a single to a dual chamber ICD. The ICD had to be upgraded because of chronotropic incompetence in all patients with signs of progressing heart failure. Data were collected in VVI(R)-pacing and after 6 and 12 months in DDD(R)-pacing with a long AV-interval and AV hysteresis to reduce ventricular pacing. RESULTS: The 6 minute walk test (392.4 ± 91.4 vs. 324.6 ± 93.3 m, P < 0.001), NYHA-classification (1.4 ± 0.3 vs. 2.6 ± 0.8, P < 0.0001), BNP (234.1 ± 73.5 vs. 410.4 ± 297.0 pg/ml, P < 0.001), left ventricular ejection fraction (49.8 ± 9.6 vs. 36.5 ± 10.9 %, P < 0.0001) and A-wave (73.6 ± 13.7 vs. 41.0 ± 14.0 cm/sec, P < 0.0001) improved with DDD(R)-pacing after 12 months. The ventricular pacing decreased (84.2 ± 18.1 vs. 1.1 ± 1.7 %, P < 0.0001) after 12 months by DDD(R)-pacing with long AV-interval (220.0 ± 10.4 ms) and AV hysteresis. CONCLUSION: Our data show a superiority of DDD(R) mode versus VVI(R) mode regarding subjective and objective parameters as NYHA-classification, BNP, 6 minute walk test, left ventricular ejection fraction and left ventricular endsystolic volume after 12 months. The improvements seem to depend on the reduction of ventricular pacing with advanced atrial contraction. But only a small number of patients needed the upgradation. Indian Pacing and Electrophysiology Group 2006-07-01 /pmc/articles/PMC1513535/ /pubmed/16943965 Text en Copyright: © 2006 Budeus et al. http://creativecommons.org/licenses/by/2.5/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Budeus, Marco Buck, Thomas Wieneke, Heinrich Erbel, Raimund Sack, Stefan Single-chamber Versus Dual-chamber Implantable Cardioverter Defibrillators: Do We Need Physiologic Pacing in The Course? |
title | Single-chamber Versus Dual-chamber Implantable Cardioverter Defibrillators: Do We Need Physiologic Pacing in The Course? |
title_full | Single-chamber Versus Dual-chamber Implantable Cardioverter Defibrillators: Do We Need Physiologic Pacing in The Course? |
title_fullStr | Single-chamber Versus Dual-chamber Implantable Cardioverter Defibrillators: Do We Need Physiologic Pacing in The Course? |
title_full_unstemmed | Single-chamber Versus Dual-chamber Implantable Cardioverter Defibrillators: Do We Need Physiologic Pacing in The Course? |
title_short | Single-chamber Versus Dual-chamber Implantable Cardioverter Defibrillators: Do We Need Physiologic Pacing in The Course? |
title_sort | single-chamber versus dual-chamber implantable cardioverter defibrillators: do we need physiologic pacing in the course? |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1513535/ https://www.ncbi.nlm.nih.gov/pubmed/16943965 |
work_keys_str_mv | AT budeusmarco singlechamberversusdualchamberimplantablecardioverterdefibrillatorsdoweneedphysiologicpacinginthecourse AT buckthomas singlechamberversusdualchamberimplantablecardioverterdefibrillatorsdoweneedphysiologicpacinginthecourse AT wienekeheinrich singlechamberversusdualchamberimplantablecardioverterdefibrillatorsdoweneedphysiologicpacinginthecourse AT erbelraimund singlechamberversusdualchamberimplantablecardioverterdefibrillatorsdoweneedphysiologicpacinginthecourse AT sackstefan singlechamberversusdualchamberimplantablecardioverterdefibrillatorsdoweneedphysiologicpacinginthecourse |