RT-201
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Role of DDDR pacing in dual
chamber ICD systems
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Enrico Adornato, Elena Maria
Fernanda Adornato, Luca Rossetti*.
Divisione di Cardiologia, Ospedali Riuniti, Reggio Calabria, *Guidant Italia, Milan, Italy
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Abstract
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The efficacy of implantable cardioverter defibrillator
(ICD) in preventing sudden cardiac death has been demonstrated by several clinical
studies. Recent technological improvements have allowed us to improve the ICD results and
to extend the indications for ICD implantation also to patients with severe left
ventricular dysfunction. Dual chamber pacing (DDD) in ICD patients is indicated by its
hemodynamic and antiarrhythmic beneficial effects. Rate adaptive dual chamber pacing
(DDDR) may be considered as a major step toward optimal management of patients with
malignant ventricular tachyarrhythmias and concomitant chronotropic incompetence, complete
AV block, exercise induced AV block, drug-induced bradycardia, recurrent paroxismal atrial
fibrillation in the context of sick sinus syndrome. This pacing modality constantly
provides an adequate chronotropic response of the heart and a further increase of cardiac
output during exercise according to the metabolic needs of the patient, improving the
patient's quality of life. Dual chamber (DDD/DDDR) ICDs that sense and pace in both the
atrium and the ventricle may improve tachyarrhythmias detection by accurate atrial and
ventricular sensing and a simple comparison of atrial and ventricular events. In the
future, hemodynamic sensors located at the tip of the standard ventricular lead may be
used both for increasing pacing rate and for distinguishing supraventricular
tachyarrhythmias from syncopal ventricular tachyarrhythmias.
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Key Words
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Implantable cardioverter defibrillator –
function, indications
dual chamber ICD, DDD pacing, DDDR pacing, VDD pacing, VVI (ventricular) pacing, DDI
pacing, DDIR pacing, severe left ventricular function, atrium/ventricle sensing-pacing,
indications, inappropriate ICD incidences, beta-blockers, postinfarction patients, dilated
cardiomyopathy, hypertrophic obstructive cardiomyopathy, R
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