DUAL-CHAMBER PACING - HOW MANY PATIENTS REMAIN IN DDD-MODE OVER THE LONG-TERM

Objective-DDD pacing is better than VVI pacing in complete heart block and sick sinus syndrome but is more expensive and demanding. In addit ion, some patients have to be programmed out of DDD mode and this may have an important impact on the cost-effectiveness of DDD pacing. The purpose of this study was to determine how many patients remain in DDD mode over the long term (up to 10 years). Design-A retrospective anal ysis of the outcome over 10 years of consecutive patients who had thei r pacemakers programmed initially in DDD mode. Setting-A district gene ral hospital. Patients-249 patients with DDD pacemakers. Sixty two pat ients (24.9%) had predominantly sick sinus syndrome and 180 (72.3%) ha d predominantly atrioventricular conduction disease. Mean (range) comp lete follow up for this group of patients was 32 months (1-10 years). Results-Cumulative survival of DDD mode was 83.5% at 60 months. Atrial fibrillation was the commonest reason for abandonment of DDD pacing. Atrial fibrillation developed in 30 patients (12%), with atrial flutte r in three (1.2%). Loss of atrial sensing or pacing, pacemaker mediate d tachycardia, and various other reasons accounted for reprogramming o ut of DDD mode in eight patients (3.2%). Overall, an atrial pacing mod e was maintained in 91% and VVI pacing was needed in only 9%. Conclusi ons-With careful use of programming facilities and appropriate seconda ry intervention, most patients with dual chamber pacemakers can be mai ntained successfully in DDD or an alternative atrial pacing mode until elective replacement, although atrial arrhythmia remains a significan t problem. There are no good reasons, other than cost, for not using d ual chamber pacing routinely as suggested by recent guidelines and thi s policy can be achieved successfully in a district general hospital p acing centre.