Double blind crossover comparison of the effects of dual chamber pacing (DDD) and ventricular rate adaptive (VVIR) pacing on neuroendocrine variables, exercise performance, and symptoms in complete heart block.
OBJECTIVE
To compare the effects of dual chamber pacing (DDD) and ventricular rate adaptive pacing (activity sensing) (VVIR) in patients with complete heart block.


METHODS
Double blind crossover comparison with one month in each pacing mode.


METHODS
10 consecutive patients aged 23-74 presenting with complete anterograde atrioventricular block at rest and on exercise and with an intact atrial rate response received Synergyst I (Medtronic) pacemakers.


METHODS
Symptom scores, maximal exercise performance on a treadmill, and the plasma concentrations of atrial natriuretic peptide, adrenaline, and noradrenaline.


RESULTS
No significant differences were identified between pacing modes in symptom scores for dyspnoea, fatigue, and mood disturbance; exercise time; and maximal oxygen consumption. One patient with intact ventriculoatrial conduction developed pacemaker syndrome during VVIR pacing. Resting plasma concentrations of atrial natriuretic peptide were raised in complete heart block and were restored to normal by DDD pacing but not by VVIR pacing. Resting plasma catecholamine concentrations were normal in complete heart block and in both pacing modes. During exercise the increase in the concentrations of all three hormones was similar in both pacing modes.


CONCLUSIONS
In patients with complete anterograde and retrograde atrioventricular block, symptoms and maximal exercise performance were no better during DDD than during VVIR pacing.
Oldroyd
K G
KG
Department of Medical Cardiology, Royal Infirmary, Glasgow.
Rae
A P
AP
Carter
R
R
Wingate
C
C
Cobbe
S M
SM
D000328:Adult; D000368:Aged; D009320:Atrial Natriuretic Factor / Q000097:blood; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004311:Double-Blind Method; D004837:Epinephrine / Q000097:blood; D015444:Exercise / Q000502:physiology; D005260:Female; D006327:Heart Block / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D010101:Oxygen Consumption; D011446:Prospective Studies
D009320:Atrial Natriuretic Factor; D009638:Norepinephrine; D004837:Epinephrine