Turk Kardiyol Dern Ars. 2012; 40(4): 331-336 | DOI: 10.5543/tkda.2012.33677

Comparison of DDD versus VVIR pacing modes in elderly patients with atrioventricular block

Barış Kılıçaslan¹, Fahriye Vatansever Ağca², Esin Evren Kılıçaslan³, Ozan Kınay⁴, Kürşat Tigen¹, Çayan Çakır⁵, Cem Nazlı⁵, Oktay Ergene^5
1Medeniyet University Goztepe Research And Training Hospital, Cardiology Department, Istanbul, Turkey
²Bahar Hospital, Cardiology Department, Bursa, Turkey
³Erenkoy Pschiatry And Neurology Research And Training Hospital, Pschiatry Department, Istanbul, Turkey
⁴Tinaztepe Hospital, Cardiology Department, Izmir, Turkey
⁵Ataturk Research And Training Hospital, Cardiology Department, Izmir, Turkey

OBJECTIVES
Dual-chamber pacing is believed to have an advantage over single-chamber ventricular pacing. The aim of this study was to determine whether elderly patients who have implanted pacemakers for complete atrioventricular block gain significant benefits from dual-chamber (DDD) pacemakers compared with single chamber ventricular (VVIR) pacemakers.

STUDY DESIGN
This study was designed as a randomized, two-period crossover study-each pacing mode was maintained for 1 month. Thirty patients (16 men, mean age 68.87±6.89 years) with implanted DDD pacemakers were submitted to a standard protocol, which included an interview, pacemaker syndrome assessment, health related quality of life (HRQoL) questionnaires assessed by an SF-36 test, 6-minute walk test (6MWT), and transthoracic echocardiographic examinations. All of these parameters were obtained on both DDD and VVIR mode pacing. Paired data were compared.

RESULTS
HRQoL scores were similar, and 6MWT results did not differ between the two groups. VVIR pacing elicited significant enlargement of the left atrium and impaired left ventricular diastolic functions as compared with DDD pacing. Two patients reported subclinical pacemaker syndrome, but this was not statistically significant.

CONCLUSION
Our study revealed that in active elderly patients with complete heart block, DDD pacing and VVIR pacing yielded similar improvements in QoL and exercise performance. However, after a short follow-up period, we noted that VVIR pacing caused significant left atrial enlargement and impaired left ventricular diastolic functions.

Keywords: Aged, cardiac pacing, methods, cross-over studies; DDD pacing; heart block/therapy; pacemaker, artificial; quality of life; VVIR pacing

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