VDD pacemaker: An effective and reliable physiological pacing modality in elderly patients

Abstract

AbstractBackgroundIn elderly patients, single chamber pacing may be considered. For sinus rhythm patients, VDD pacemaker (PM), by preserving atrial sensing, is a more physiological mode than VVI devices. This study aims to evaluate the long‐term performance of VDD PM in elderly patients with atrioventricular block (AVB).MethodsWe conducted a retrospective, observational study of 200 elderly patients (≥75 years) with AVB and normal sinus rhythm who consecutively implanted VDD PM between 2016 and 2018. Baseline clinical characteristics were analyzed, complications related to pacemaker implantation were assessed and a 3‐years follow‐up (FUP) was made.ResultsMean age was 84 ± 5 years. After 3‐years FUP, 90.5% (n = 181) of the patients preserved their original VDD mode. Only 19 patients (9.5%) switched to VVIR mode, 5.5% (n = 11) due to P‐wave undersensing and 4% (n = 8) due to permanent AF. Those patients had a less amplitude of sensed P wave at baseline [median value of 1.30 (IQR 0.99–2.0) versus 0.97 (IQR 0.38–1.68), p = 0.04]. One third of the patients died during the FUP, 89% (n = 58) from non‐cardiovascular causes. All‐cause, CV, and non‐CV mortality did not relate with atrial sensing loss during FUP (p = 0.58, p = 0.38 and p = 0.80, respectively). However, atrial sensing loss during FUP was associated with de novo atrial fibrillation (12.7% vs. 31.6%, p = 0.038).ConclusionVDD pacing is a reliable pacing modality in elderly patients even in long‐term. The majority of VDD‐paced elderly patients maintained their original VDD mode program, with good atrial sensing.