Physiologic VDD versus Nonphysiologic VVI Pacing in Canine 3rd‐Degree Atrioventricular Block

Historically, ventricular demand, nonphysiologic (VVI) pacing has been the most commonly used modality to treat 3rd‐degree atrioventricular (AV) block. The goal of this study was to determine the feasibility of using a commercial, single‐lead, physiologic (VDD) pacemaker in dogs with 3rd‐degree AV block. Furthermore, we hoped to characterize and identify differences in the radiographic, echocardiographic, neurohormonal, and quality of life consequences of physiologic versus nonphysiologic pacing. We evaluated 10 dogs during a 12‐week crossover study. Acutely, rate‐matched physiologic pacing reduced pulmonary capillary wedge pressure by 19% compared with nonphysiologic pacing. VDD pacing significantly reduced left atrial size normalized to body weight, left atrial‐to‐aortic root ratio, and left ventricular end‐systolic dimension and increased fractional shortening, aortic Doppler velocity, cardiac output, and stroke volume compared with VVI pacing. Variable rate VDD pacing resulted in a significantly slower heart rate (HR) during echocardiography than fixed‐rate (100 bpm) VVI pacing. AV synchronous pacing reduced circulating N‐terminal proatrial natriuretic peptide (ANP), norepinephrine (NOR), and epinephrine (EPI) concentrations compared with asynchronous pacing. There were no significant differences in systemic blood pressure, thoracic radiographs, or owner‐perceived quality of life. The median percentage of AV synchronous pacing during the VDD modality was 99.8% (range, 1.2 to 99.9%). This study confirms the potential to achieve physiologic pacing with a commercial, single‐lead system in dogs. VDD pacing improved hemodynamics and neurohormonal profiles over asynchronous pacing although the long‐term clinical benefits of these changes remain to be determined.