Single-Chamber versus Dual-Chamber Pacing for High-Grade Atrioventricular Block

• Published in: The New England journal of medicine Vol. 353; no. 2; pp. 145 - 155
• Main Authors: Toff, William D, Camm, A. John, Skehan, J. Douglas
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 14-07-2005
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Cardiac arrhythmia; Cardiac dysrhythmias; Cardiac Pacing, Artificial - adverse effects; Cardiac Pacing, Artificial - methods; Cardiac Pacing, Artificial - mortality; Cardiology. Vascular system; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - mortality; Cardiovascular Diseases - prevention & control; Female; Follow-Up Studies; General aspects; Heart; Heart attacks; Heart Block - therapy; Heart failure; Humans; Incidence; Male; Medical research; Medical sciences; Pacemaker, Artificial - adverse effects; Risk; United Kingdom > UK; Medicine; Instrumental stimulation; Arrhythmia; Heart block; Heart disease; Atrioventricular bloc; Instrumentation therapy; Cardiovascular disease; Conduction disorder; Comparative study; High grade; High malignancy
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa042283

Patients with high-grade atrioventricular block usually require the implantation of a permanent pacemaker. Retrospective studies have suggested that dual-chamber pacemakers reduce the risk of atrial fibrillation, stroke, heart failure, and death in this setting, as compared with single-chamber ventricular pacemakers. In a randomized trial comparing these two pacing methods, however, no significant advantage of dual-chamber pacing was demonstrated.
In a randomized trial comparing these two pacing methods, no significant advantage of dual-chamber pacing was demonstrated.
Cardiac pacing is the established treatment for high-grade atrioventricular block, but the appropriate pacing mode remains the subject of debate.
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Single-chamber ventricular pacing prevents bradycardia and death from ventricular standstill, but dual-chamber pacing better emulates normal cardiac physiology by restoring atrioventricular synchrony and matching the ventricular pacing rate to the sinus rate. As a result, dual-chamber pacing, as compared with single-chamber ventricular pacing, improves hemodynamic function,
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but the clinical benefit is uncertain.
Nonrandomized studies suggest that dual-chamber pacing is associated with a lower incidence of atrial fibrillation, stroke, and heart failure than is single-chamber pacing.
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There is also evidence . . .