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. 2002 Jan;10(1):3–7.

DDD versus DDDR pacing: effects on the occurrence of atrial arrhythmias and the quality of life in patients with the sick sinus syndrome

HJ Schrickx, JH Ruiter, R Antenbrink, A Maarsse, MI Sedney
PMCID: PMC2499671  PMID: 25696025

Abstract

Objective

To evaluate the efficiency of adaptive rate dual-chamber pacing to control the recurrence of atrial arrhythmias in patients with the brady-tachy variant of the sick sinus syndrome (SSS) with or without associated AV block.

Method

A total of 23 patients were included in this double-blind, randomised, crossover study. In each patient a CPI 1230 dual pacemaker was implanted. The pacemaker was programmed blind to the investigator in a randomised order to four different pacing modalities for a period of four weeks each: DDD, lower rate 60 PPM; DDD, lower rate 80 PPM; DDD-R, lower rate 60 PPM; and DDD-R, lower rate 80 PPM. The incidence of atrial tachyarrhythmia events was determined by interrogating the event counter of the pacemaker, 24-hour Holter monitoring in each mode and documentation of the need for reprogramming, electro-cardioversion and antiarrhythmic medication. The quality of life in each pacing mode was assessed by quality-of-life questionnaires and patient diaries.

Results

None of the pacing modes were significantly better for the whole patient group with respect to the suppression of atrial arrhythmias. However, there were significant individual differences in the occurrence of atrial tachyarrhythmias and tolerance for each mode.

Conclusion

In dual-chamber pacing for patients with the brady-tachy variant of the SSS, the ideal programming cannot be predicted. Individual mode setting with usage of the pacemaker event counter should be performed to find the best antitachycardia mode.

Keywords: atrial fibrillation, overdrive pacing, prevention

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Andersen H. R., Nielsen J. C., Thomsen P. E., Thuesen L., Mortensen P. T., Vesterlund T., Pedersen A. K. Long-term follow-up of patients from a randomised trial of atrial versus ventricular pacing for sick-sinus syndrome. Lancet. 1997 Oct 25;350(9086):1210–1216. doi: 10.1016/S0140-6736(97)03425-9. [DOI] [PubMed] [Google Scholar]
  2. Andersen H. R., Thuesen L., Bagger J. P., Vesterlund T., Thomsen P. E. Prospective randomised trial of atrial versus ventricular pacing in sick-sinus syndrome. Lancet. 1994 Dec 3;344(8936):1523–1528. doi: 10.1016/s0140-6736(94)90347-6. [DOI] [PubMed] [Google Scholar]
  3. Attuel P., Pellerin D., Mugica J., Coumel P. DDD pacing: an effective treatment modality for recurrent atrial arrhythmias. Pacing Clin Electrophysiol. 1988 Nov;11(11 Pt 2):1647–1654. doi: 10.1111/j.1540-8159.1988.tb06289.x. [DOI] [PubMed] [Google Scholar]
  4. Bennett M. A., Pentecost B. L. The pattern of onset and spontaneous cessation of atrial fibrillation in man. Circulation. 1970 Jun;41(6):981–988. doi: 10.1161/01.cir.41.6.981. [DOI] [PubMed] [Google Scholar]
  5. Brignole M., Gammage M., Jordaens L., Sutton R. Report of a study group on ablate and pace therapy for paroxysmal atrial fibrillation. Barcelona Discussion Group. Working Group on Arrhythmias of the European Society of Cardiology. Europace. 1999 Jan;1(1):8–13. doi: 10.1053/eupc.1998.0014. [DOI] [PubMed] [Google Scholar]
  6. Connolly S. J., Kerr C. R., Gent M., Roberts R. S., Yusuf S., Gillis A. M., Sami M. H., Talajic M., Tang A. S., Klein G. J. Effects of physiologic pacing versus ventricular pacing on the risk of stroke and death due to cardiovascular causes. Canadian Trial of Physiologic Pacing Investigators. N Engl J Med. 2000 May 11;342(19):1385–1391. doi: 10.1056/NEJM200005113421902. [DOI] [PubMed] [Google Scholar]
  7. Coumel P., Friocourt P., Mugica J., Attuel P., Leclercq J. F. Long-term prevention of vagal atrial arrhythmias by atrial pacing at 90/minute: experience with 6 cases. Pacing Clin Electrophysiol. 1983 May;6(3 Pt 1):552–560. doi: 10.1111/j.1540-8159.1983.tb05295.x. [DOI] [PubMed] [Google Scholar]
  8. Hesselson A. B., Parsonnet V., Bernstein A. D., Bonavita G. J. Deleterious effects of long-term single-chamber ventricular pacing in patients with sick sinus syndrome: the hidden benefits of dual-chamber pacing. J Am Coll Cardiol. 1992 Jun;19(7):1542–1549. doi: 10.1016/0735-1097(92)90616-u. [DOI] [PubMed] [Google Scholar]
  9. Misier A. R., Opthof T., van Hemel N. M., Defauw J. J., de Bakker J. M., Janse M. J., van Capelle F. J. Increased dispersion of "refractoriness" in patients with idiopathic paroxysmal atrial fibrillation. J Am Coll Cardiol. 1992 Jun;19(7):1531–1535. doi: 10.1016/0735-1097(92)90614-s. [DOI] [PubMed] [Google Scholar]
  10. Murgatroyd F. D., Nitzsché R., Slade A. K., Limousin M., Rosset N., Camm A. J., Ritter P. A new pacing algorithm for overdrive suppression of atrial fibrillation. Chorus Multicentre Study Group. Pacing Clin Electrophysiol. 1994 Nov;17(11 Pt 2):1966–1973. doi: 10.1111/j.1540-8159.1994.tb03782.x. [DOI] [PubMed] [Google Scholar]
  11. Roth J. A., Berkovits B. V., Fisher J. D., Ferrick K. J., Kim S. G. Implementation of a new DDDR algorithm for tachycardia prevention and treatment utilizing an implantable RAM-based software-controlled pacemaker. J Electrocardiol. 1992;24 (Suppl):136–145. doi: 10.1016/s0022-0736(10)80036-6. [DOI] [PubMed] [Google Scholar]
  12. Saksena S., Prakash A., Hill M., Krol R. B., Munsif A. N., Mathew P. P., Mehra R. Prevention of recurrent atrial fibrillation with chronic dual-site right atrial pacing. J Am Coll Cardiol. 1996 Sep;28(3):687–694. doi: 10.1016/0735-1097(96)00232-x. [DOI] [PubMed] [Google Scholar]
  13. Spencer W. H., 3rd, Zhu D. W., Markowitz T., Badruddin S. M., Zoghbi W. A. Atrial septal pacing: a method for pacing both atria simultaneously. Pacing Clin Electrophysiol. 1997 Nov;20(11):2739–2745. doi: 10.1111/j.1540-8159.1997.tb05431.x. [DOI] [PubMed] [Google Scholar]
  14. Sutton R. Pacing in atrial arrhythmias. Pacing Clin Electrophysiol. 1990 Dec;13(12 Pt 2):1823–1827. doi: 10.1111/j.1540-8159.1990.tb06897.x. [DOI] [PubMed] [Google Scholar]
  15. Wijffels M. C., Kirchhof C. J., Dorland R., Allessie M. A. Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats. Circulation. 1995 Oct 1;92(7):1954–1968. doi: 10.1161/01.cir.92.7.1954. [DOI] [PubMed] [Google Scholar]

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