Single-chamber Versus Dual-chamber Implantable Cardioverter Defibrillators: Do We Need Physiologic Pacing in The Course?

Budeus, Marco and Buck, Thomas and Wieneke, Heinrich and Erbel, Raimund and Sack, Stefan (2006) Single-chamber Versus Dual-chamber Implantable Cardioverter Defibrillators: Do We Need Physiologic Pacing in The Course? [Journal (Paginated)]

Full text available as:

[img] HTML


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.

Item Type:Journal (Paginated)
Keywords:brain natriuretic peptide; 6 minute walk test; single chamber ICD; dual chamber ICD
Subjects:JOURNALS > Indian Pacing and Electrophysiology Journal
ID Code:5211
Deposited By: Indian Pacing and Electrophysiology, Journal
Deposited On:28 Oct 2006
Last Modified:11 Mar 2011 08:56

References in Article

Select the SEEK icon to attempt to find the referenced article. If it does not appear to be in cogprints you will be forwarded to the paracite service. Poorly formated references will probably not work.

1. 1.Siebels J, Kuck KH and CASH Investigators. Implantable cardioverter defibrillator compared with antiarrhythmic drug treatment in cardiac arrest survivors (the Cardiac Arrest Study Hamburg). Am Heart J 1994;127: 1139-1144.

2. Moss AJ, Hall WJ, Cannom DS, Daubert JP, Higgins SL, Klein H, Levine JH, Saksena S, Waldo AL, Wilber DJ, Brown MW, Heo M for the Multicenter Automatic Defibrillator Implantation Trial Investigators. Improved survival with an implanted defibrillator in patients with coronary disease and high risk for ventricular arrhythmia. N Engl J Med 1996;335: 1933-1944.

3. The Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators. A comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. N Eng J Med 1997;337: 1576-1583.

4. Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, Daubert JP, Higgins SL, Brown MW, Andrews ML for the Multicenter Automatic Defibrillator Implantation Trial II Investigators. Prophylactic implantation of the defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 2002;346: 877-883.

5. Connolly SJ, Gent M, Roberts RS, Dorian PD, Roy D, Sheldon RS, Mitchell LB, Green MS, Klein GJ, O´Brien B for the CIDS Investigators. Canadian Implanted Defibrillator Study (CIDS). A randomized trial of the implantable cardioverter defibrillator against amiodarone. Circulation 2000;101: 1297-1302.

6. Maron BJ, Shen WK, Link MS, Epstein AE, Almquist AK, Daubert JP, Bardy GH, Favale S, Rea RF, Boriani G, Estes NA 3rd., Spirito P. Efficacy of implantable cardioverter defibrillators for the prevention of sudden death in patients with hypertrophic cardiomyopathy. N Eng J Med 2000;342: 365-373.

7. Lee KL, Hafley G, Fisher JD, Gold MR, Prystowsky EN, Talajic M, Josephen ME, Packer DL, Buxton AE for the Multicenter Unsustained Tachycardia Trial Investigators. Effect of implantable defibrillators on the arrhythmic events and mortality in the Multicenter Unsustained Tachycardia Trial. Circulation 2002;106: 233-238

8. Bigger JT, Whang W, Rottman JN, Kleiger RE, Gottlieb CD, Namerow PPB, Steinman RC, Estes NA 3rd. Mechanisms of death in the CABG Patch trial: a randomized trial of implanted cardiac defibrillator prophylaxis in patients at high risk of death after coronary artery bypass grafting surgery. Circulation 1999; 99: 1416-1421.

9. Kadish A, Dyer A, Daubert JP, Quigg R, Esters M, Anderson KP, Calkins H, Hoch D, Goldberger J, Shalaby A, Sanders WE, Schaechter A, Levine JH for the Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation (DEFINITE) Investigators. Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. N Eng J Med 2004;350: 2151-2158.

10. Seidl K, Hauer B, Schwick NG, Zahn R, Senges J. Comparison of metoprolol and sotalol in preventing ventricular tachyarrhythmias after the implantation of a cardioverter/defibrillator. Am J Cardiol 1998;82: 744-748.

11. Dolack GL. Clinical predictors of implantable cardioverter-defibrillator shocks (results of the CASCADE trial). Cardiac Arrest in Seattle, Conventional versus Amiodaron Drug Evaluation. Am J Cardiol 1994;73: 237-241.

12. Singer I, Al-Khalidi HR, Niazi I, Tchou P, Simmons T, Henthorn R, Holroyde M, Brum JM. Azimilide decreases recurrent ventricular tachyarrhythmias in patients with implantable cardioverter defibrillators. J Am Coll Cardiol 2004;43: 39-43.

13. Pacifico A, Hohnloser SH, Williams JH, Tao B, Saskena S, Henry PD, Prystowsky EN for the d,l-Sotalol Implantable Cardioverter-Defibrillator Study Group. Prevention of implantable-defibrillator shocks by treatment with sotalol. N Eng J Med 1999;340: 1855-1862.

14. Dorian P, Borggrefe M, Al-Khalidi HR, Hohnloser SH, Brum JM, Tatla DS, Brachmann J, Myerburg RJ, Cannom DS, van der Laan M, Holroyde MJ, Singer I, Pratt CM on behalf of the SHock Inhibition Evaluation with azimiLDe (SHIELD) Investigators. Placebo-controlled, randomized clinical trial of azimilide for prevention of ventricular tachyarrhythmias in patients with an implantable cardioverter defibrillator. Circulation 2004;110: 3646-3654.

15. The DAVID Trial Investigators. Dual Chamber pacing or ventricular buckup pacing in patients with an implantable defibrillator. The Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA 2002;288: 3115-3123.

16. Sweeney MO, Hellkamp AS, Ellenbogen KA, Greenspon AJ, Freedman RA, Lee KL, Lamas GA for the MOde Selection Trail (MOST) Investigators. Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation 2003;107: 2932-2937.

17. Tantengco MVT, Thomas RL, Karpawich PP. Left ventricular dysfunction after long-term right ventricular apical pacing in the young. J Am Coll Cardiol 2001;37: 2093-2010.

18. Lee MA, Dae MW, Landberg JJ, Griffin JC, Chin MC, Finkbeiner WE, O´Connell JW, Botvinick E, Scheinman MM, Rosenqvist M. Effects of long-term right ventricular apical pacing on left ventricular perfusion, innervation, function and histology. J Am Coll Cardiol 1994;24: 225-232.

19. Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, Gutgesell H, Reichek N, Sahn D, Schnittger I, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards Subcommittee on Quantitation of Two-Dimensional Echocardiography. J Am Soc Echo 1989;2:358–367.

20. St John Sutton M, Otterstat JE, Plappert T, Parker A, Sekarski D, Keane MG, Poole-Wilson P, Lubsen K: Quantitation of left ventricular volumes and ejection fraction in post-infarction patients from biplane and single plane two-dimensional echocardiograms. Eur Heart J 1998;19:808–816.

21. Spain MG, Smith MD, Grayburn PA, Harlamert EA, DeMaria AN. Quantitative assessment of mitral regurgitation by color Doppler flow imaging: angiographic and hemodynamic correlations. J Am Coll Cardiol 1989;13: 585–590.

22. Santini M, Ansalone G, Auriti A, Magris B, Pandozi C, Altamura G. Indications for dual-chamber (DDD) pacing in implantable cardioverter-defibrillator patients. Am J Cardiol 1996;78 (Suppl. 5A): 116-118.

23. Sutander A, Solimon S, Kaddaha R, Vloka ME, Steinberg JS. Should all patients receive a dual chamber device? Unanticipated use of the implantable defibrillator as a pacemaker. J Am Coll Cardiol 2000;35 (Abs): 1119

24. Geelen P, Lorga A, Chauvin M, Wellens F, Brugada P. The value of DDD pacing in patients with an implantable cardioverter defibrillator. PACE 1997;20 (Pt. II): 177-181.

25. Karpawich PP, Justice CD, Cavitt DL, Chang CH.. Developmental sequelae of fixed-rate ventricular pacing in the immature canine heart: an electrophysiologic, hemodynamic, and histopathologic evaluation. Am Heart J. 1990;119: 1077-1083.

26. Adomian GE, Beazell J. Myofibrillar disarray produced in normal hearts by chronic electrical pacing. Am Heart J. 1986;112:79-83.

27. Paxinos G, Katritsis D, Kakouros S, Toutouzas P, Camm AJ. Long-term effect of VVI pacing on atrial and ventricular function in patients with sick sinus syndrome. Pacing Clin Electrophsiol 1998;21 (4 Pt 1): 728-734.

28. Sparks PB, Mond HG, Vohra JK, Yapanis AG, Grigg LE, Kalman JM. Mechanical remodeling of the left atrium after loss of atrioventricular synchrony. A long-term study in humans. Circulation. 1999;100:1714-1721.

29. Yamamoto K, Kodama K, Masuyama T, Hirayama A, Nanto S, Mishima M, Kitabatake A, Kamada T. Role of atrial contraction and synchrony of ventricular contraction in the optimisation of ventriculoarterial coupling in humans. Br Heart J. 1992;67: 361-367.

30. Lascault G, Frank R, Iwa T, Girodo S, Fontaine G, Grosgogeat Y. Comparison of DDD and 'VVI-R like' pacing during moderate exercise: echo-Doppler study. Eur Heart J. 1992;13: 914-917.

31. Pearson AC, Janosik DL, Redd RM, Buckingham TA, Labovitz AJ. Hemodynamic benefit of atrioventricular synchrony: prediction from baseline Doppler-echocardiographic variables. J Am Coll Cardiol. 1989;13:1613-1621.

32. Mitchell LE, Richardson DA, Davies AJ, Bexton RS, Kenny RA. Prevalence of hypotensive disorders in older patients with a pacemaker in situ who attend the Accident and Emergency Department because of falls or syncope. Europace. 2002;4: 143-147.


Repository Staff Only: item control page