14th International Congress
THE "NEW FRONTIERS"
OF ARRHYTHMIAS 2000

Jan. 29 - Feb. 5, 2000
Marilleva, Trento, Italy

RT-210

New concepts of dual-chamber or biventricular pacing therapy in patients with life-threatening ventricular tachyarrhythmias

Hans-Joachim Trappe, Michael Achtelik, Petra Pfitzner, Bernward Voigt, Peter Weismüller.
Department of Cardiology and Angiology, Ruhr-University, Bochum, Germany

Introduction

Sudden cardiac death is one of the major causes of mortality in western countries with an incidence of approximately 450.000 victims per year in the United States and 100000 sudden death patients per year in Germany¹. Multiple pharmacologic and nonpharmacologic therapeutic options are currently available for the treatment of patients who have survived previous episodes of life-threatening ventricular tachyarrhythmias^2,3. Disappointing results with antiarrhythmic agents, including class III drugs, as well as encouraging results from some implantable cardioverter defibrillator (ICD) trials have led to nonpharmacologic alternatives gaining increased acceptance as a treatment for patients with this pathology^4-6. Furthermore, subsequent to the introduction of the concept of the ICD, there have been many technologic innovations that have permitted vast improvements in therapy options and diagnostic features⁷. Technical innovations have allowed precipitous reductions in pulse generator volume and mass without sacrificing longevity or clinical effectiveness⁸. Recently, ICDs with dual-chamber pacing, sensors for rate-adaptive pacing and biventricular pacing possibilities have been introduced in clinical cardiology to allow atrioventricular and biventricular synchrony with an improved cardiac output^9,10.

TABLE I–Indications for dual-chamber pacing in implantable cardioverter-defibrillator patients

AV=atrioventricular, DDDR-dual chamber pacing with rate responsive mode

TABLE II–Patient characteristics of DDD-ICD recipients

Pt

Age

Sex

Dis

T-Arr

SVA-Arr

EF

NYHA

DFT

ICD-Typ

 1

69

m

CAD

SMVT

SSS

57%

II

 8 J.

Ventak AV

 2

69

m

CAD

SMVT

AV II

41%

III

12 J.

Ventak AV

 3

70

m

CAD

SMVT

CCS

35%

III

20 J.

Ventak AV

 4

68

m

CAD

SMVT

AFib

29%

III

 3 J.

Ventak AV II

 5

61

m

CAD

SMVT

AFib

45%

II

10 J.

Ventak AV II

 6

71

m

CAD

VF

AV I

40%

I

 9 J.

Ventak AV II

 7

64

m

CAD

SMVT

AFib

45%

III

 5 J.

Ventak AV II

 8

60

m

DCM

VF

AV I

35%

II

12 J.

Ventak AV II

 9

67

f

CAD

VF

–

20%

III

 6 J.

Ventak AV II

10

65

f

CAD

SMVT

–

60%

I

11 J.

Ventak AV II

11

74

m

CAD

SMVT

AV II

60%

II

 5 J.

Ventak AV II

12

62

m

CAD

SMVT

–

55%

II

 7 J.

Ventak AV III

13

67

m

CAD

SMVT

AV I

78%

I

 5 J.

Ventak AV II

14

55

m

CAD

SMVT

AV I

54%

II

 7 J.

Ventak AV III

15

68

f

CAD

VF

AV I

19%

III

17 J.

Ventak AV II

16

55

m

CAD

SMVT

AV I

41%

II

 9 J.

Ventak AV III

17

61

m

CAD

VF

Afib

51%

I

12 J.

Ventak AV III

18

77

m

CAD

VF

AV I

55%

I

11 J.

Ventak AV III

19

63

f

CAD

SMVT

Afib

60%

I

 7 J.

Ventak AV III

20

68

m

CAD

SMVT

Afib

65%

I

10 J.

Ventak AV III

21

49

m

CAD

VF

AV III

47%

II

 3 J.

Ventak AV III

22

79

f

CAD

SMVT

AV I

40%

I

14 J.

Ventak AV II

23

79

f

CAD

SMVT

Afib

54%

II

 3 J.

Ventak AV III

24

62

m

CAD

SMVT

Afib

65%

I

15 J.

Ventak AV III

25

57

m

CAD

SMVT

Afib

70%

I

10 J.

Ventak AV III

26

75

m

DCM

VF

Afib

28%

II

 9 J.

Ventak AV II

27

66

m

CAD

SMVT

Afib

27%

III

 3 J.

Ventak AV II