S-166
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Dual chamber pacemaker
defibrillator:
clinical results
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Ali Oto.
Hacettepe University School of Medicine, Ankara, Turkey
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Recently published trials have confirmed that in
ventricular fibrillation survivors or in patients with sustained ventricular tachycardia
the implantable cardioverter defibrillators have a role to increase the survival of the
patients1. However there have been some limitations in
the practice of ICD: the high incidence of inappropriate ICD therapy due to
supraventricular tachyarrhythmias up to 25% in some series despite improved detection
algorithms has been a major challenge2. Therefore there
is an obvious need to have a better detection capability for supraventricular
tachyarrhythmias which has been achieved by atrial signal through atrial sensing in the
new generation of ICDs.
However even the detection is better in those devices still there is another
limitation in providing the pacing. Until recently implantable cardioverter defibrillators
could provide only fixed rate ventricular pacing although the preservation of
atrioventricular synchrony particularly in patients with sick sinus syndrome and with
limited left ventricular function has been shown to reduce morbidity and even mortality3,4. This issue is important from the clinical practice
point of view. According to a recent study in a series of 139 ICD patients 25 (18%) were
in need of antibradycardia pacing. Based on current indications DDD pacing was indicated
in 20 (80%) of them5.
Surely implantation of a dual chamber pacemaker in addition to an ICD is always an
option. However such an approach potentially may create other problems. Interaction of
pacemakers with already implanted devices has been repeatedly reported6-8.
Moreover the addition of another device and leads are not free of trouble. Therefore an
implantable device provides dual chamber pacing capability potentially of benefit both in
terms of better detection algorithm for atrial signals and giving the opportunity of dual
chamber pacing.
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Key Words
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Implantable cardioverter defibrillator – new
perspectives
dual chamber ICD, clinical results, ICD inappropriate incidences, atrial sensing-pacing,
atriventricular association algorithm, French multicenter trial, VAN detection algorithms,
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