Document Detail

Clinical and hemodynamic comparison of VVI versus DDD pacing in patients with DDD pacemakers.
MedLine Citation:
PMID:  3341209     Owner:  NLM     Status:  MEDLINE    
To identify better those subgroups of pacemaker recipients who will benefit from dual chamber pacing, 19 patients with DDD pacemakers that were physiologically paced were entered into a blinded, randomized protocol comparing long-term VVI versus DDD pacing. Patients were evaluated in each of the pacing modes for exercise performance, cardiac chamber size, cardiac output, functional status and health perception. Eight patients (42%) insisted on early crossover, from VVI to DDD pacing, after only 1.8 +/- 1.4 weeks because of symptoms consistent with pacemaker syndrome. Overall, 12 patients preferred DDD pacing and no patient preferred VVI pacing (p = 0.001). Percent fractional shortening (30 +/- 8 vs 24 +/- 6%, p = 0.009) and cardiac output (6.3 +/- 2.6 vs 4.4 +/- 2.2 liters/min, p = 0.0001) where significantly greater in the DDD mode. Exercise duration was greater during DDD compared with VVI pacing (11.3 +/- 3.7 vs 10.1 +/- 3.7 minutes, p = 0.006). However, it was only in the crossover subgroup that DDD pacing resulted in significant improvement in exercise performance and health perception compared with VVI pacing. This subgroup of patients was characterized by an intrinsic sinus rate of less than 60 beats/min (4/8 vs 0/11, p = 0.006), ventriculoatrial (VA) conduction (4/8 vs 1/11, p = 0.048), greater increase in exercise peak systolic blood pressure from VVI to DDD mode (21 +/- 12 vs 4 +/- 13 mm Hg, p = 0.02) and greater improvement in exercise capacity from VVI to DDD pacing (2.2 +/- 1.2 vs 0.6 +/- 1.4 minutes, p = 0.03) compared with the other 11 patients.(ABSTRACT TRUNCATED AT 250 WORDS)
D E Rediker; K A Eagle; S Homma; L D Gillam; J W Harthorne
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of cardiology     Volume:  61     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  1988 Feb 
Date Detail:
Created Date:  1988-03-02     Completed Date:  1988-03-02     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  323-9     Citation Subset:  AIM; IM    
Department of Medicine (Cardiac Unit), Massachusetts General Hospital, Boston 02114.
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MeSH Terms
Aged, 80 and over
Blood Pressure
Cardiac Output
Cardiac Pacing, Artificial / adverse effects,  methods*
Exercise Test
Heart Block / physiopathology,  therapy*
Heart Rate
Middle Aged
Monitoring, Physiologic
Pacemaker, Artificial
Sick Sinus Syndrome / physiopathology,  therapy*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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