Frequency and associations of symptomatic deterioration after dual-chamber defibrillator implantation in patients with ischemic or idiopathic dilated cardiomyopathy

Abstract

Sequential atrioventricular (AV) pacing has been proposed as a treatment for congestive heart failure (CHF) due to its ability to maintain chronotropic competence and optimal AV synchrony 1 Auricchio A. Sommariva L. Salo R.W. Scafuri A. Chiariello L. Improvement of cardiac function in patients with severe congestive heart failure and coronary artery disease by dual chamber pacing with shortened AV delay. Pacing Clin Electrophysiol. 1993; 16: 2034-2043 Crossref PubMed Scopus (131) Google Scholar , 2 Hochleitner M. Hortnagl H. Hortnagl H. Fridrich L. Gschnitzer F. Long-term efficacy of physiologic dual-chamber pacing in the treatment of end-stage idiopathic dilated cardiomyopathy. Am J Cardiol. 1992; 70: 1320-1325 Abstract Full Text PDF PubMed Scopus (170) Google Scholar ; it is increasingly being used in this patient population. Controlled studies have failed to confirm a significant improvement in left ventricular (LV) systolic function. 3 Innes D. Leitch J.W. Fletcher P.J. VDD pacing at short atrioventricular intervals does not improve cardiac output in patients with dilated heart failure. Pacing Clin Electrophysiol. 1994; 17: 959-965 Crossref PubMed Scopus (81) Google Scholar , 4 Gold M.R. Feliciano Z. Gottlieb S.S. Fisher M.L. Dual-chamber pacing with a short atrioventricular delay in congestive heart failure a randomized study. J Am Coll Cardiol. 1995; 26: 967-973 Abstract Full Text PDF PubMed Scopus (223) Google Scholar , 5 Linde C. Gadler F. Edner M. Nordlander R. Rosenqvist M. Rydén L. Results of atrioventricular synchronous pacing with optimized delay in patients with severe congestive heart failure. J Am Coll Cardiol. 1995; 75: 919-923 Abstract Full Text PDF Scopus (214) Google Scholar Anecdotal evidence exists that an exacerbation of symptomatic cardiac dysfunction may occur with right ventricular (RV) apical pacing, presumably due to dyssynchronous ventricular contraction. Although ventricular pacing is rarely used with single-chamber implantable cardioverter defibrillators, with dual-chamber systems many patients are paced in the ventricular chamber for much of the time. In this study we evaluated the effects of RV apical pacing in patients with heart failure who received dual-chamber defibrillators.