Bottom Line In patients with an indication for an implantable defibrillator, ventricular backup pacing is superior to dual-chamber pacing in terms of hospitalization rate and possibly overall survival.
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. These drugs can cause AV-block or chronotropic incompetence resulting in a higher percentage of ventricular pacing.
The ICD had to be upgraded because of chronotropic incompetence in all patients with signs of progressing heart failure. Results The 6 minute walk test The ventricular pacing decreased 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. Many studies showed the benefit for ICD in primary and secondary prevention of sudden cardiac death in patients with different cardiac diseasess [ 1 - 9 ]. In addition ICD is superior to antiarrhythmic therapy for preventing sudden cardiac death [ 13578 ].
One side effect of ICD therapy is the painful shock needed to terminate the life-threatening tachycardias. Different studies showed a reduction of the ICD therapy by an additional antiarrhythmic therapy [ 10 - 14 ].
Patients having a reduced left ventricular function had worsening of their cardiac function with higher percentage of ventricular pacing [ 15 - 18 ].
Physiologic pacing or no pacing has to be preferred in patients with lower cardiac function Single chamber icd wiki ICD implantation because of worsening of their cardiac function by ventricular pacing.
But the accompanying antiarrhythmic therapy e. Therefore patients with accompanying antiarrhythmic therapy for preventing painful shocks should be paced physiologically or not paced at all to prevent a worsening of their cardiac function.
Methods We examined patients with different heart diseases and implanted single chamber ICD since in our study. The ICD had to be implanted at least six months before the inclusion into our study without a pacing indication at the time of the implant. We used the interrogable data of the ICD to look for the percentage of ventricular pacing every three months.
Patients were excluded in case of an indication for resynchronization therapy 16 patientssecond no patient or third no patient degree AV block, an inability to walk no patient or a life expectancy below 6 months no patient.
The inclusion criterion was an upgradation from single to dual-chamber ICD because of the indication of pacing like chronotropic incompetence.
In addition the medication had to be unchanged for 3 months. Demographic data, medications and medical history were gathered by a patient interview and the review of their medical record at baseline and after six and twelve months.
The interrogable data of the ICD were analysed for the percentage of ventricular pacing every three months.
The subjective NYHA classification and objective parameters [brain natriuretic peptide BNP6 minute walk test, echocardiography] were evaluated at baseline within one week before upgrading to a dual-chamber ICD after six and twelve months in DDD R -pacing which were routine clinical practice in our clinic.
The 6-minute walk tests were performed randomly during working hours at baseline, after 6 and 12 months. Patients were instructed to walk as far as possible within 6 minutes with a running wheel, with standardized encouragement and breaks when necessary.
At the time of echocardiographic evaluation the physician was blinded for the ICD pacing mode. Echocardiography The physicians were blinded to the mode of the ICD during the study. The mean of five measurements was taken as the result. Doppler colour flow mapping was used to identify the presence or absence of mitral valve regurgitation.
Gain settings were optimized by reducing the gain to the point where background noise disappeared. The direction of the MR jet was assessed from both parasternal and apical views, and the area of the largest clearly definable colour flow disturbance was traced in each view as an index of the severity of mitral valve regurgitation [ 21 ].
Data sets were tested with regard to normal distribution. A measurement of the linear association between two variables was evaluated using Pearson correlation coefficient. All statistical tests were two-tailed. Results The ICD had to be upgraded because of chronotropic incompetence in 12 patients.
These patients had a higher incidence of amiodarone therapy Table 1.
Paul, MNMedtronic Inc. Minneapolis, MNalphabetical order.single chamber pacemaker an implanted cardiac pacemaker with only one lead, placed in either the atrium or the ventricle.
wandering atrial pacemaker a condition in which the site of origin of the impulses controlling the heart rate shifts from one point to another within the atria, almost with every beat.
Feb 28, · Dual-chamber devices have demonstrated superiority over single-chamber detection in only one prospective randomized trial, called the 1+1 trial. 1 In this trial, patients with slow VT were implanted with a dual-chamber ICD that was either programmed to dual- or single- chamber detection.
The combined endpoint was the . More than half of all new ICD implants in the U.S. are single-chamber devices. "Approximately 75 percent of ICD patients have no history of atrial fibrillation at the time they receive a device," said Edward J.
Schloss, MD, director of cardiac electrophysiology, The Christ Hospital, Cincinnati. The single-chamber ICD results from the PainFree SST trial were published January 27, 1, continuing the Medtronic legacy of investigation in shock reduction technology.
PainFree SST is the only large shock-reduction trial to report inappropriate shock rates for single-chamber ICD patients. Since these single-chamber ventricular devices cannot sense atrial activity, pacing with these devices can result in simultaneous atrial and ventricular contraction leading to bothersome symptoms associated with backflow of blood from the atria (the pacemaker syndrome).
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