AV WENCKEBACH POINT AS A LONG-TERM PREDICTOR OF RIGHT VENTRICULAR PACING DEPENDENCE

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Patients presenting symptomatic sick sinus syndrome with preserved AV node function with indication for permanent pacemaker implantation theoretically benefit form single chamber device (AAI) as it represents a more physiologic pacing mode and it reduces complication rates. The incidence of high degree AV block in patients with sick sinus syndrome was reported to be between 0.6 and 3 % annually. We hypothesized that the baseline AV wenckebach point (WP) at the time of AAI pacemaker implantation represent a valid predictor of the futur need for a ventricular lead implantation. We retrospectively analyzed 211 patients who underwent double chamber pacemaker (DDD) implantation who had more than one AV WP measure over a follow-up of up to 7 years. The primary outcome was the percentage of right ventricular pacing at follow-up stratified for the baseline WP. Secondary outcomes included the evolution of the mean WP and right ventricular pacing percentage over time. There is a linear relationship between baseline WP and right ventricular pacing at follow-up (correlation coefficient -0.68) With a baseline value greater than 120 bpm, patients have 9% RV pacing burden at follow-up while an initial value ≤ 100 bpm will result in a 54% RV pacing burden at follow-up. Also, there was no significant difference in the mean WP and percentage of right ventricular pacing at 6 years of follow-up. Routine measurement of the WP should be part of the assessment of patients with sick sinus syndrome in order to better determine if they are candidate for single chamber AAI pacemaker implantation. If the WB is > than 120 bpm, implantation of an AAI pacemaker seems reasonable as suggested by a low burden of ventricular pacing at follow-up and a stable WP measure over time.