title: Impact of dual chamber pacing on the incidence of atrial and ventricular tachyarrhythmias in recipients of implantable cardioverter defibrillators.
abstract: Recent observations suggest that frequent dual-chamber pacing in recipients of implantable cardioverter defibrillators (ICD) may adversely influence clinical outcomes. This prospective, multicenter study examined the relationship between the frequency of atrial (%AP) and ventricular pacing (%VP) and the incidence of atrial (AT) and/or ventricular tachyarrhythmias (VT) in a standard ICD population. A total of 141 consecutive patients with primary and secondary ICD indications were studied. Continuous arrhythmia detection with a dual-chamber ICD revealed paroxysmal AT in 60 (43%) and VT in 72 (51%) patients within 6 months of device implantation. Far-field oversensing of ventricular signals occurred in 13% of all "atrial tachy response" mode switches. Without adjustment for covariates, a higher %AP was associated with an increased incidence of AT (P < 0.05). However, this association remained only weakly significant after adjustment for covariates using a multivariate model. High New York heart failure functional classes correlated significantly with AT (P = 0.02) and VT (P = 0.007). Rate-modulated pacing, programmed in 1/3 of patients, correlated with occurrence of AT (P = 0.006), but not with occurrence of VT. With respect to dual-chamber pacing, a %AP >/= 48% combined with a %VP > 40% was associated with an increased probability for VT. In conclusion, AT and VT occurred frequently within 6 months after dual-chamber ICD implantation. High rates of DDD/R stimulation were associated with a trend toward higher incidence of AT, VT, or both.
authors.affiliation: Department of Cardiology, Salzburger Landeskliniken, Paracelsus Private Medical University, Austria. b.strohmer@salk.at
authors.forename: Bernhard
authors.initials: B
authors.lastname: Strohmer
authors.forename: Johann
authors.initials: J
authors.lastname: Mermi
authors.forename: Eduardo
authors.initials: E
authors.lastname: Castellanos
authors.forename: Harald
authors.initials: H
authors.lastname: Mayr
authors.forename: Jaswinder
authors.initials: J
authors.lastname: Gill
authors.forename: Antonio Asso
authors.initials: AA
authors.lastname: Abadia
authors.forename: Martin
authors.initials: M
authors.lastname: Kuehl
authors.forename: Christian
authors.initials: C
authors.lastname: Wolpert
mesh_terms: D000368:Aged; D017147:Defibrillators, Implantable; D004867:Equipment Design; D005260:Female; D006325:Heart Atria; D006801:Humans; D015994:Incidence; D008297:Male; D015999:Multivariate Analysis; D010138:Pacemaker, Artificial; D011446:Prospective Studies; D013610:Tachycardia / Q000453:epidemiology* / Q000517:prevention & control*; D017180:Tachycardia, Ventricular / Q000453:epidemiology / Q000517:prevention & control*