SPC365

Usefulness of the physiological VDD pacemaker in elderly patients with normal sinus rhythm

Session: Posters (Sessão 3 - Écran 2) - Arritmias 3 - Vários
Speaker: Sofia S. Martinho

Congress: CPC 2022
Topic: C. Arrhythmias and Device Therapy
Theme: 09. Device Therapy
Subtheme: 09.1 Antibradycardia Pacing
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Sofia s. Martinho; Maria João Telo; José Paulo Almeida; Natália António; Luis Elvas; Lino Gonçalves
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#2a2a2a"><span style="background-color:white">BACKGROUND: In frail elderly patients or when </span></span></span></span><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif">atrioventricular block<span style="color:#2a2a2a"><span style="background-color:white"> (AVB) is paroxysmal, and pacing anticipated to be infrequent, single chamber pacing (VVI or VDD) may be considered as it carries a lower complication rate compared with DDD devices. For sinus rhythm patients, the single lead VDD, by preserving atrial sensing, &nbsp;is a more physiological mode than VVI devices, with comparable time procedure and complication rates. However, there are few data assessing the performance of VDD pacemakers in elderly patients, with AVB and sinus rhythm. </span></span>We want to evaluate the 3-years performance of VDD pacemakers</span></span><span style="font-size:10pt"> (PM)</span><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"> in frailty elder patients with AVB.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="color:#000000"><span style="font-family:&quot;Times New Roman&quot;,serif; font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">METHODS</span></span></span><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif">: We conducted a retrospective, observational study of 200 elderly (</span><span style="font-family:Symbol">&gt;=</span></span><span style="font-family:&quot;Times New Roman&quot;,serif; font-size:10pt"><span style="font-family:Calibri,sans-serif">75 years) patients with AVB </span></span><span style="font-family:&quot;Times New Roman&quot;,serif; font-size:10pt">and normal sinus rhythm </span><span style="font-family:&quot;Times New Roman&quot;,serif; font-size:10pt"><span style="font-family:Calibri,sans-serif">who consecutively implanted VDD </span></span><span style="font-family:&quot;Times New Roman&quot;,serif; font-size:10pt">PM</span><span style="font-family:&quot;Times New Roman&quot;,serif; font-size:10pt"><span style="font-family:Calibri,sans-serif"> between 2016 and 2018. Baseline clinical characteristics were analyzed, and a 3-years follow-up was performed: atrial undersensing, atrial fibrillation (AF), heart failure (HF) hospitalization, cardiovascular (CV) and non-CV death.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">RESULTS: Mean age was </span></span></span><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">84&plusmn;5 years and 55% were female. The study population presented several comorbidities: 74% had atrial hypertension, 49% dyslipidemia, 35% chronic kidney disease and 28% diabetes. After 3-years follow-up most of the patients (90%; n=162) were still programmed in their original mode with good atrial sensing. Due to permanent AF, 4%(n=8) patients had been switched to VVIR mode and 5.5% (n=11) due to P-wave undersensig. 0ne-third (n=65) died during follow-up, 89% (n=58) due to non-CV causes. </span></span></span><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif">Low amplitude P-wave (&lt;0.5mV) at baseline had a numerical, non-statistically significant association with atrial undersensig and AF at 3-years (p=0.14 and p=0.77, respectively). Atrial undersensing during follow-up didn&rsquo;t relate with all-cause death and HF hospitalization (p=0.58 and p=0.64, respectively), but was associated with atrial fibrillation (12.7% vs 31.6%, p=0.038).</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">CONCLUSION: A significantly larger number of VDD-paced elderly patients </span></span></span><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif">maintain <span style="color:black">their original mode program with good atrial sensing. Moreover, atrial undersensing did not influence mortality or HF hospitalization rate. These results reinforce the benefit of VDD use among frail and elderly patients.</span></span></span></span></span></span></p>