Pacemaker Programming, Physiologic Pacing Settings, and Clinical Outcomes in Real-world Practice: Results from the OPTI-MIND Clinical Study

Mauro Biffi

doi:10.19102/icrm.2016.070101

Abstract

Pacemaker Programming, Physiologic Pacing Settings, and Clinical Outcomes in Real-world Practice: Results from the OPTI-MIND Clinical Study

Highlights

IntroductionCardiac pacing has become a wellestablished treatment for symptomatic bradyarrhythmias
Over the past decades, cardiac pacing has become a wellestablished treatment for symptomatic bradyarrhythmias
Dualchamber pacing or single-chamber atrial pacing is recommended over single-chamber ventricular pacing in patients with sinus node dysfunction, and for patients with atrioventricular block (AVB) except in specific clinical situations

Summary

Introduction

Cardiac pacing has become a wellestablished treatment for symptomatic bradyarrhythmias. Over the past decades several landmark trials have compared a number of cardiovascular outcomes among patients randomized to different pacing modalities.[1,2,3,4,5] only recently a general consensus on the optimal recommended pacing mode for selected rhythm disorders has been agreed and incorporated into a statement on pacemaker (PM) mode selection from HRS/ACCF.[6] Dualchamber pacing or single-chamber atrial pacing is recommended over single-chamber ventricular pacing in patients with sinus node dysfunction, and for patients with atrioventricular block (AVB) except in specific clinical situations (e.g. sedentary patients or those with multiple comorbidities). Several specific programmable options are available in modern PMs, in favor of pacing mechanisms that could mimic the physiologic function of the heart These include an optimized management of the programmed pacing rate (lower rate, rate hysteresis, rate responsiveness), of atrioventricular (AV) conduction (automatic search of intrinsic AV conduction or reversion from AAI to DDD mode), and other specific algorithms for reduction of symptoms. The OPTI-MIND (Clinical Outcome of Pacemaker paTIents according to pacing Modality and primary INDications) study was designed to collect data on midterm clinical outcome for PM patients and to stratify both clinical characteristics and outcome of these subjects based on the ‘‘real-world’’ choice of devices and their settings when analyzed with respect to a theoretically ‘‘physiologic programming.’’

Methods

Results

Discussion

Conclusion