Comparative Functional Effects of Chronic Ventricular Demand and Atrial Synchronous Ventricular Inhibited Pacing

RAYMOND YEE, David G Benditt, WILLIAM J. KOSTUK, PATRICK T. KO, PAUL PURVES, GEORGE J. KLEIN

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

We compared the effects of chronic ventricular inhibited (VVI) and atrial synchronous ventricular inhibited (VDD) pacing on functional capacity in 8 patients with complete atrioventricular heart block. Permanent VDD (Medtronic #2409, ASVIP) pacemakers were implanted in four men and four women (age range 27–76 years, mean 58.9 ± 18.4 years), and randomly assigned to a three‐month period of VDD or VVI pacing in this single blinded, crossover study. Functional capacity was assessed by questionnaire, graded treadmill exercise testing and radionuclide angiocardiography prior to pacemaker implant and following each pacing period. Following 3 months of pacing in each of VVI and VDD pacing modes, maximum heart rate [83.4 ± 14 vs 134.9 ± 16.4 beats/min. p < 0.001) and double product (147.5 ± 58.3 vs 218.9 ± 52.7, p < .001) were greater with VDD pacing. Although exercise duration on treadmill exercise testing (5.3 ± 2.9 vs 6.9 ± 3.1 minutes, p < 0.1) was greater in the VDD mode, the difference was not significant. Similarly, there was no significant difference in functional capacity as measured by questionnaire scores (50.1 ± 8.4 vs 46.9 ± 8.9, p < 0.1) or in left ventricular ejection fraction for the two pacing modes [.54 vs .55, p < .5). Only one patient reported a subjective improvement with physiologic [VDD] pacing, whereas the remaining patients stated no preference. We conclude that VDD pacing offers improved maximal cardiac work during exercise compared to VVI pacing. However, many patients may be limited in maximal exercise capacity by non‐cardiac factors and may not appreciate this difference.

Original languageEnglish (US)
Pages (from-to)23-28
Number of pages6
JournalPacing and Clinical Electrophysiology
Volume7
Issue number1
DOIs
StatePublished - Jan 1984

Keywords

  • VDD pacing
  • VVI pacing
  • exercise capacity

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