Comparison of long-term follow-up in patients with single or dual chamber pacemakers: is downtrodden or take its rightful place?

Abstract

Background: In this study, at a median follow-up of 7.9 years (3-22), the patients who had implanted either single chamber (VDD) or dual chamber (DDD) pacemakers were compared according to the changes in left ventricular function, pacemaker-related complications, and mortality. Methods: In between January 1985 and August 2016, a total of 1238 patients, who presented with a diverse set of clinical situations and had implanted a single or double chamber pacemaker were retrospectively included in the present study. Age, prior history of hypertension, diabetes mellitus, heart failure and coronary artery disease did not differ between the groups (P>0.05). Results: When pre-implantation echocardiographic data was compared to the post-implantation values, in both groups, there were a significant decrease in LVEF (P<0.001) and increase in LVEDD (P<0.001), LA size (P<0.001) and sPAP (P<0.008). Results: When the patients who had a pacemaker due to a complete AV block were analysed, regardless of having VDD or DDD pacemaker, a significant decrease in LVEF was observed (P<0.0001). When the current rhythm at the last visit was evaluated, we found that patients with VDD were mostly in sinus rhythm (P<0.001). During the long-term follow-up, pacemaker-related complications (tamponade, infection, and pneumothorax) did not differ between the two groups (P>0.05). The comparison of the two pacemaker groups according to the decline in LVEF (<=% 40) did not show any significant difference (P=0.122). Conclusions: Patients with VDD or DDD pacemakers have both a decline in LVEF and an increase in LV diameter during the long-term follow-up. Mortality and complication rates were not different between the two groups. When compared to the DDD group, left ventricular dimensions and functions were better preserved in VDD group.