© 1999 by European Society of Cardiology
Programming a fixed long atrioventricular delay is not effective in preventing ventricular pacing in patients with sick sinus syndrome
Department of Cardiology, Skejby University Hospital Brendstrupgaardsvej, Aarhus, Denmark
AIM: Most patients with sick sinus syndrome (SSS) and normal atrioventricular (AV) conduction receive dual chamber (DDDR) pacemakers. Programming a long AV delay has been proposed to avoid ventricular pacing. The present study aimed to evaluate ventricular stimulation in SSS patients with DDDR pacemakers with a long AV delay.
METHODS AND RESULTS: Thirty eight patients treated with DDDR pacemakers with a fixed long AV delay (300 ms) were studied. Data from the pacemaker event recorder were retrieved after 3 months and every year after implantation. Ten patients underwent 24 h Holter recording. Mean follow-up was 11·9±8·3 months. Median daily number of paced events in the ventricle was 2659 (25th–75th percentiles: 775–21 315) with a large inter-individual variation. The proportion of paced events in the ventricle correlated weakly with the baseline PQ interval (Spearman’s 
0·331, P=0·043). In 12/38 patients the mean daily number of paced events in the ventricle exceeded 10 000. During 24 h Holter recording, pacemaker arrhythmias caused by repetitive retrograde atrioventricular conduction, known as VA (ventriculoatrial) conduction, occurred in five out of 10 patients.
CONCLUSION: DDDR pacing with a fixed long AV delay is inefficient in reducing ventricular pacing in one third of patients and is associated with a high risk of arrhythmias caused by repetitive retrograde AV conduction, and therefore cannot be recommended for general use in SSS patients. |P[s8a|P](Europace 1999; 1: 113–120)
Key Words: AV delay, sick sinus syndrome, pacing, DDD, event recording, follow-up, pacemaker syndrome
*Correspondence: Henning Rud Andersen, MD, DMSc, Department of Cardiology, Skejby University Hospital, Brendstrupgaardsvej, 8200 Aarhus N. Denmark.
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