Patients Implanted for AV Block: How Many Subsequently Develop Sinus Node Dysfunction?
Dual-chamber atrio-ventricular synchronous pacing (DDD) has been shown in many studies to provide better hemodynamic parameter [1,2] and quality of life [3, 4] than VVI pacing in patients with A-V block. The complexity of implant procedures, the unreliability of some atrial leads, the extra time required for atrial lead fixation, the complexity of follow-up, the cost and the need for some patients to be programmed out of DDD created reluctance to implant dual-chamber pacemakers, and VVI pacing has been recommended as an acceptable treatment in the absence of retrograde conduction . In order to avoid problems related to atrial leads, in patients with normal sinus node function and A-V block, newer single-lead systems with atrial dipoles have been shown to provide reliable atrial sensing and to ensure reliable AV synchrony in VDD mode [6, 7]. In patients implanted with this type of pacemaker it is important to know the real incidence of sinus node dysfunction over time. A low incidence would favor single-lead VDD systems, whereas a high incidence would make DDD or DDDR pacemaker systems more effective.
KeywordsAtrial Fibrillation Sinus Node Pacemaker Implantation Sinus Bradycardia Sick Sinus Syndrome
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