Increased percentage of Atrial Pace Ventricular Pace was associated with increased cardiovascular morality in patients with a DDD pacemaker

Background Compared to single-chamber pacing system, dual chamber atrioventricular pacing system (DDD) was associated with reduced mortality and hospitalization for heart failure. High percentage of right ventricular pacing was reported to be associated with high cardiovascular events. However, another meta-analysis study showed ventricular pacing reduction modalities did not improve adverse clinical outcomes. Hence, the relationship between the pacing percentage and clinical outcomes is necessary to be further studied. Methods The present study was designed to evaluate the association of total and cardiovascular mortality with the percentages of atrial sense ventricular sense (ASVS), atrial sense ventricular pace (ASVP), atrial pace ventricular sense (APVS), and atrial pace ventricular pace (APVP) in patients with a DDD pacemaker. Study subjects were selected from patients arranged for permanent pacemaker follow-up at our special clinic. 177 patients with a DDD pacemaker were included. We collected their pacemaker follow-up data at their first visit for pacemaker follow-up after permanent pacemaker implantation. Results Among the 177 subjects, the mean follow-up to mortality was 2.44 ± 1.03 years. There were 22 and 10 patients documented as total and cardiovascular mortality. In the Cox proportional hazards regression analysis, old age (P = 0.030) and low hemoglobin (P = 0.007) were the predictors of increased total mortality and increased creatinine (P = 0.023) and high percentage of APVP (hazard ratio [HR], 1.030; 95% confidence interval [CI], 1.012–1.049; P = 0.001) were the predictors of increased cardiovascular mortality after multivariable analysis. Conclusion In patients with a DDD pacemaker, old age and low hemoglobin were associated with increased total mortality and high creatinene and high percentage of APVP were associated with increased cardiovascular mortality after multivariable analysis. Hence, reduction in unnecessary atrial and ventricular pacing in patients with a DDD pacemaker might be useful in improving cardiovascular prognosis.