Dual-chamber pacing

Wilkoff BL, Cook JR, Epstein AE, et al. Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator the Dual Chamber and WI Implantable Defibrillator (DAVID) Trial, [see comment]. JAMA 2002 288 3115-23. 

Hochleitner M, Hortnagl H, Ng CK, Gschnitzer F, Zechmann W. Usefulness of physiologic dual-chamber pacing in drug-resistant idiopathic dilated cardiomyopathy. [see comment]. Am. J. Cardiol. 1990 66 198-202. 

Auricchio A, Sommariva L, Salo RW, 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, [see comment]. Pacing Clin. Electrophysiol. 1993 16 2034 3. 

Brecker SJ, Xiao HB, Sparrow J, Gibson DG. Effects of dual-chamber pacing with short atrioventricular delay in dilated cardiomyopathy, [see comment, erratum appears in Lancet 1992 Dec 12 340(8833) 1482]. Lancet 1992 340 1308-12. 

Capucci A, Romano S, Puglisi A, et al. Dual chamber pacing with optimal AV delay in congestive heart failure a randomized study. Europace 1999 1 174-8. 

FIGURE 11.9 Illustration of a dual-chamber pacing system. 

Fig 7.1 Posteroanterior a) and laterolateral (b) chest radiograph of a man referred for lead-related endocarditis. The patient has a dual chamber pacing system in the right pectoral region and three additional abandoned leads, for a total of two atrial and three ventricular leads... 

The AVI is an important programmable parameter in dual chamber pacing modes. It represents the interval between the atrial event and the ventricular event (Fig. 3.19). Hemodynamically, the pacemaker AVI simulates the human PR interval, allowing time for atrial contraction and ventricular filling. Therefore, the AVI must be adjusted to optimize hemodynamic function. There are... 

Fig. 3.28 Algorithm to avoid ventricular pacing. One algorithm to minimize ventricular pacing varies between the AAIR and DDDR function. In (a), AAIR is present As shown in (b), when there is AV block for one transient beat, dual chamber pacing will occur. In (c), there is back-up dual chamber pacing. In (d), AV block has subsided and atrial pacing again occurs.

Table 4.10 Venous access for dual-chambered pacing. Venous cutdown Isolate one or two veins Percutaneous Two separate sticks and sheath applications Percutaneous Two electrodes down one large sheath Percutaneous Retained guidewire (Belott technique)...

Dual-chambered pacing calls for the introduction of an atrial and ventricular electrode. The cutdown technique is less suited for this approach because all too often the cephalic vein can hardly acconunodate one electrode, and even less two. The percutaneous approach appears ideally suited for dual-chambered pacing as there is potential for unlimited access to the venous circulation. Various options for dual-chambered pacing venous access are listed in Table 4.10. There are four percutaneous approaches for dual-chambered pacing. 

The axillary vein is becoming a common venous access site for pacemaker and defibrillator implantations, given the concerns of the subclavian crush and the requirement for insertion of multiple electrodes for dual-chambered pacing and a large complex electrode for transvenous nonthoracotomy defibrillation. There are now a number of reliable techniques for axillary venous access (Table 4.11). 

Upgrading Techniques for Dual-Chambered Pacing and Defibrillator Systems... 

There is an ongoing debate with respect to the safety and efficacy of blind subclavian puncture. Furman has demonstrated remarkable efficiency of the cutdown approach for dual-chambered pacing, particularly with unipolar leads. The cutdown technique was less successful for bipolar leads via a single... 

Byrd C. Current chnical applications of dual-chamber pacing. In Zipes DP, ed. Proceedings of a symposium. Minneapolis Medtronics, 1981 71. 

Nielson JC, Kristensen L, Anderson HR, et al. A randomized comparison of atrial and dual-chambered pacing in 177 consecutive patients with sick sinus syndrome. J Am Coll Cardiol 2003 42 614. 

DDD/R Dual-chamber pacing with a long atrioventricular delay is commonly used giving ventricular backup pacing should the AV node fail. 

Hesselson AB, Parsonnet V, Bernstein AD, Bonavita GJ. Deleterious effects of long-term single-chamber ventricular pacing in patients with sick sinus syndrome the hidden benefits of dual-chamber pacing. J Am Coll Cardiol. 1992 19 1542-1549. 

Kristensen L, Nielsen JC, Mortensen PT, Pedersen OL, Pedersen AK, Andersen HR. Incidence of atrial fibrillation and thromboembolism in a randomised trial of atrial versus dual chamber pacing in 177 patients with sick sinus syndrome. 

Prakash A, Saksena S, Ziegler PD, Lokhandwala T, Hettrick DA, Delfaut P, Nanda NC, Wyse DG. Dual site right atrial pacing can improve the impact of standard dual chamber pacing on atrial and ventricular mechanical function in patients with symptomatic atrial fibrillation further observations from the dual site atrial pacing for prevention of atrial fibrillation trial. J Interv Card Electrophysiol. 2005 12 177-187. 

Nishimui a RA, Hayes DL, Holmes DR, Jr., Tajik AJ. Mechanism of hemodynamic improvement by dual-chamber pacing for severe left ventricular dysfunction an acute Doppler and catheterization hemodynamic study. J Am Coll Cardiol 1995 25 281-8. 

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