Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026
Adverse outcomes due to atrioventricular synchrony loss induced by temporary VVI pacing in patients with pre-existing DDD stimulation: insights from a device recall scenario.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Martignani Cristian, Massaro Giulia, Spadotto Alberto, Bartoli Lorenzo, Angeletti Andrea, Ziacchi Matteo, Diemberger Igor, Biffi Mauro
Аннотация
AIMS: Temporary reprogramming of dual-chamber (DDD) pacemakers to non-synchronous ventricular modes (VVI/VVIR) may be required in selected clinical scenarios, but short-term consequences of abrupt atrioventricular (AV) synchrony loss remain incompletely characterized.Leveraging a unique natural experiment, this study aimed to quantify the clinical and echocardiographic consequences of temporary VVI/VVIR pacing in patients in sinus rhythm chronically adapted to DDD stimulation.
METHODS AND RESULTS: In this prospective observational study, 93 patients (79.9 ± 16.0 years; 63.4% AV block) with recalled DDD pacemakers were reprogrammed to VVI/VVIR for 6 months, followed by DDD restoration. Serial assessments included echocardiography, BNP, and 6-min walk test. Primary endpoints were changes in left ventricular ejection fraction (LVEF) and heart failure (HF) hospitalizations; secondary endpoints included echocardiographic remodelling parameters, functional capacity, quality of life, and atrial fibrillation. Clinical events were tracked for 12 months. Ventricular pacing remained >88% throughout. During the VVI/VVIR period, HF hospitalizations increased compared with the subsequent DDD restoration period (22.6% vs. 6.7%, P < 0.001). This was accompanied by adverse echocardiographic remodelling, a decline in LVEF from 57.3% to 53.0% (P < 0.001), and a marked BNP increase from 155 to 260 pg/mL (P < 0.001). After DDD restoration, clinical and structural recovery was incomplete: LVEF improved to 54.8% and BNP decreased to 210 pg/mL, but both remained significantly worse than baseline (P < 0.05).
CONCLUSION: Temporary loss of AV synchrony in chronically DDD-paced patients was associated with rapid, severe, and only partially reversible clinical and echocardiographic deterioration. These findings underscore that continuous AV synchrony is a critical determinant of clinical stability.
METHODS AND RESULTS: In this prospective observational study, 93 patients (79.9 ± 16.0 years; 63.4% AV block) with recalled DDD pacemakers were reprogrammed to VVI/VVIR for 6 months, followed by DDD restoration. Serial assessments included echocardiography, BNP, and 6-min walk test. Primary endpoints were changes in left ventricular ejection fraction (LVEF) and heart failure (HF) hospitalizations; secondary endpoints included echocardiographic remodelling parameters, functional capacity, quality of life, and atrial fibrillation. Clinical events were tracked for 12 months. Ventricular pacing remained >88% throughout. During the VVI/VVIR period, HF hospitalizations increased compared with the subsequent DDD restoration period (22.6% vs. 6.7%, P < 0.001). This was accompanied by adverse echocardiographic remodelling, a decline in LVEF from 57.3% to 53.0% (P < 0.001), and a marked BNP increase from 155 to 260 pg/mL (P < 0.001). After DDD restoration, clinical and structural recovery was incomplete: LVEF improved to 54.8% and BNP decreased to 210 pg/mL, but both remained significantly worse than baseline (P < 0.05).
CONCLUSION: Temporary loss of AV synchrony in chronically DDD-paced patients was associated with rapid, severe, and only partially reversible clinical and echocardiographic deterioration. These findings underscore that continuous AV synchrony is a critical determinant of clinical stability.
Предметные рубрики MeSH
AgedAged, 80 and overFemaleHumansMaleAtrial FibrillationAtrioventricular BlockAtrioventricular NodeCardiac Pacing, ArtificialEchocardiographyHeart FailureHospitalizationNatriuretic Peptide, BrainPacemaker, ArtificialProspective StudiesQuality of LifeRecovery of FunctionRisk FactorsStroke VolumeTime FactorsTreatment OutcomeVentricular Function, LeftVentricular RemodelingWalk TestMiddle Aged