Pacemaker programming in patients with first-degree AV-block: Programming pattern and possible consequences

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title = "Pacemaker programming in patients with first-degree AV-block: Programming pattern and possible consequences",
abstract = "Background: The optimal way of pacing in patients with an indication for pacing and concomitant first-degree atrioventricular (AV)–block is not known, and consequently, firm guidelines on this topic are lacking. This study explored the current pacemaker programming pattern in patients with first-degree AV-block who have a dual chamber pacemaker without cardiac resynchronization. Methods: The study was a retrospective chart review conducted at Duke University Hospital. Patients receiving a pacemaker due to sinus node dysfunction with coexistent first-degree AV-block were studied. Baseline demographics and characteristics, as well as pacemaker programming parameters and follow-up data, were collected through chart review. Preimplantation and postimplantation electrocardiograms were analyzed. Results: A total of 74 patients were included (mean age, 75 ± 11 y; 53{\%} men). The mean ± SD preimplant PR interval and QRS duration was 243 ± 46 and 110 ± 30 milliseconds, respectively. A history of atrial fibrillation was present in 49{\%} of the patients, and 77{\%} had a normal left ventricular ejection fraction. The majority of patients (65{\%}) had their pacemakers programmed to atrial pacing (AAI/DDD +/−R), whereas 32{\%} and 2.7{\%} of the pacemakers were programmed to AV-sequential pacing (DDD) and ventricular pacing (VVI), respectively. There were no significant differences in baseline characteristics or electrocardiogram measures between patients programmed to the 3 pacing modes. Patients with pacemakers programmed to AAI had a lower ventricular pacing percentage at follow-up (8 vs 55, and 46{\%} [DDD and VVI, respectively]; P <.001). Conclusions: There was no evident association between baseline characteristics and programmed pacing mode in patients with first-degree AV-block. The choice of pacing mode affects long-term pacing burden, which in turn has been shown to influence outcome.",
keywords = "first-degree AV-block, pacemaker programming, sinus node dysfunction",
author = "F. Holmqvist and B. Rathakrishnan and Jackson, {L. R.} and K. Campbell and Daubert, {J. P.}",
year = "2018",
month = "6",
doi = "10.1002/hsr2.39",
language = "English",
volume = "1",
journal = "Health Science Reports",
issn = "2398-8835",
publisher = "John Wiley and Sons Inc.",
number = "6",