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Several clinical and experimental studies have shown that unnecessary right ventricular pacing in sinus node disease can be detrimental. Inter- and intra-ventricular asynchrony imposed by right ventricular pacing may cause reduction in contractility and relaxation of left ventricle, worsening mitral regurgitation, regional redistribution of myocardial perfusion and oxygen consumption, and asymmetrical hypertrophy of left ventricular wall. In some patients, sinus node disease coexists with impaired atrioventricular conduction. The optimal pacing mode in this population is not determined. Minimizing right ventricular pacing can preserve inter- and intra-ventricular synchrony. On the other hand, longer atrioventricular delay may cause atrioventricular asynchrony. The aim of this study was to prospectively assess the impact of minimizing right ventricular pacing in patients with DDD pacemaker implanted for sinus node disease and prolonged PQ interval on exercise capacity, cardiac function and quality of life.

Minimizing right ventricular pacing in patients with sinus node disease and prolonged PQ interval: The impact on exercise capacity