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Impact of Dual Chamber Pacing on the Incidence of Atrial and Ventricular Tachyarrhythmias in Recipients of Implantable Cardioverter Defibrillators
Author(s) -
STROHMER BERNHARD,
MERMI JOHANN,
CASTELLANOS EDUARDO,
MAYR HARALD,
GILL JASWINDER,
ABADIA ANTONIO ASSO,
KUEHL MARTIN,
WOLPERT CHRISTIAN
Publication year - 2005
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2005.00002.x
Subject(s) - medicine , cardiology , implantable cardioverter defibrillator , incidence (geometry) , single chamber , ventricular pacing , ventricular tachycardia , population , heart failure , physics , optics , environmental health
Recent observations suggest that frequent dual‐chamber pacing in recipients of implantable cardioverter defibrillators (ICD) may adversely influence clinical outcomes. This prospective, multicenter study examined the relationship between the frequency of atrial (%AP) and ventricular pacing (%VP) and the incidence of atrial (AT) and/or ventricular tachyarrhythmias (VT) in a standard ICD population. A total of 141 consecutive patients with primary and secondary ICD indications were studied. Continuous arrhythmia detection with a dual‐chamber ICD revealed paroxysmal AT in 60 (43%) and VT in 72 (51%) patients within 6 months of device implantation. Far‐field oversensing of ventricular signals occurred in 13% of all “atrial tachy response” mode switches. Without adjustment for covariates, a higher %AP was associated with an increased incidence of AT (P < 0.05). However, this association remained only weakly significant after adjustment for covariates using a multivariate model. High New York heart failure functional classes correlated significantly with AT (P = 0.02) and VT (P = 0.007). Rate‐modulated pacing, programmed in 1/3 of patients, correlated with occurrence of AT (P = 0.006), but not with occurrence of VT. With respect to dual‐chamber pacing, a %AP ≥ 48% combined with a %VP > 40% was associated with an increased probability for VT. In conclusion, AT and VT occurred frequently within 6 months after dual‐chamber ICD implantation. High rates of DDD/R stimulation were associated with a trend toward higher incidence of AT, VT, or both.