Patients, mean age 70 years, with automatic implantable cardioverter-defibrillators treated with dual-chamber rate responsive pacing (DDDR-70) have a higher mortality than patients with backup ventricular pacing (VVI-40) at 3.7-year follow-up.
BACKGROUND
One study showed in 506 patients with automatic implantable cardioverter-defibrillators (AICDs) that the mortality at 1-year follow-up was 6.5% with ventricular backup pacing at 40/minute (VVI-40) versus 10.1% in patients with dual-chamber rate responsive pacing at 70/minute (DDDR-70).


METHODS
We performed a retrospective study to determine all-cause mortality in all patients at a university hospital who had AICDs without indications for antibradycardia pacing. Of 535 patients, mean age 70 +/- 12 years, 271 patients had backup ventricular pacing with a VVI-40, and 264 patients had dual-chamber rate responsive pacing with a DDDR-70.


RESULTS
At 3.7-year mean follow-up, all-cause mortality was 19% (50 of 264 patients) in patients with DDDR-70 pacing versus 11% (29 of 271 patients) with VVI-40 pacing (p < .01).


CONCLUSIONS
Because of the increased mortality, increased cost, and complexity for dual-chamber rate responsive pacing in patients with AICDs, concomitant DDDR pacing at a rate of 70/minute in patients without an indication for antibradycardia pacing is not warranted.
Department of Medicine, Cardiology Division, Westchester Medical Center/New York Medical College, Macy Pavilion, Room 138, Valhalla, NY 10595, USA.
Rishi
R
Sukhija
Wilbert S
WS
Aronow
Carmine
C
Sorbera
Kiran
K
Yalamanchili
Martin
M
Cohen
D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006785:Hospitals, University; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*