Pacemaker Device And Mode Selection

Publication Date: August 1, 2012

Consensus Recommendations

Sinus Node Dysfunction

Dual-chamber pacing (DDD) or single-chamber atrial pacing (AAI) is recommended over single-chamber ventricular pacing (VVI) in patients with SND and intact AV conduction. (A, I)
701
Dual-chamber pacing is recommended over single-chamber atrial pacing in patients with SND. (B, I)
701
Rate adaptive pacing can be useful in patients with significant symptomatic chronotropic incompetence and its need should be reevaluated during follow-up. (C, IIa)
701
In patients with SND and intact AV conduction, programming dual-chamber pacemakers to minimize ventricular pacing can be useful for prevention of atrial fibrillation (AF). (B, IIa)
701
AAI pacing may be considered in selected patients with normal AV and ventricular conduction. (B, IIb)
701
Single-chamber VVI pacing may be considered in instances where frequent pacing is not expected or the patient has significant comorbidities that are likely to influence survival and clinical outcomes. (C, IIb)
701
Dual-chamber pacing or single-chamber atrial pacing should not be used in patients in permanent or longstanding persistent AF in whom efforts to restore or maintain sinus rhythm are not planned. (C, III (no benefit))
701

AV Node Disease

Dual-chamber pacing is recommended in patients with AV block. (C, I)
701
Single-chamber ventricular pacing is recommended as an acceptable alternative to dual-chamber pacing in patients with AV block who have specific clinical situations that limit the benefits of dual-chamber pacing. These include, but are not limited to, sedentary patients, those with significant medical comorbidities likely to impact clinical outcomes, and those in whom technical issues, such as vascular access limitations, preclude or increase the risk of placing an atrial lead. (B, I)
701
Dual-chamber pacing is recommended over single-chamber ventricular pacing in adult patients with AV block who have documented pacemaker syndrome. (B, I)
701
Single-lead, dual-chamber VDD pacing can be useful in patients with normal sinus node function and AV block (e.g., the younger patient with congenital AV block). (C, IIa)
701
VVI pacing can be useful in patients following AV junction ablation, or in whom AV junction ablation is planned, for rate control of AF due to the high rate of progression to permanent AF. (B, IIa)
701
Dual-chamber pacing should not be used in patients with AV block in permanent or longstanding persistent AF in whom efforts to restore or maintain sinus rhythm are not planned. (C, III (no benefit))
701

Hypersensitive Carotid Sinus Syndrome

Dual-chamber or single-chamber ventricular pacing can be useful for patients with hypersensitive carotid sinus syndrome. (C, IIa)
701
Single-chamber AAI pacing is not recommended for patients with hypersensitive carotid sinus syndrome. (C, III (no benefit))
701

Neurocardiogenic Syncope

Dual-chamber pacing can be useful for neurocardiogenic syncope. (C, IIa)
701
Single-chamber AAI pacing is not recommended for neurocardiogenic syncope. (C, III (no benefit))
701

Long QT

Dual-chamber or atrial pacing compared to ventricular pacing is recommended for symptomatic or high-risk patients with congenital long QT syndrome. (C, I)
701

Hypertrophic Cardiomyopathy

Dual-chamber pacing can be useful for patients with medically refractory, symptomatic hypertrophic cardiomyopathy with significant resting or provoked left ventricular outflow obstruction. (C, IIa)
701
Single-chamber (VVI or AAI) pacing is not recommended for patients with medically refractory, symptomatic hypertrophic cardiomyopathy. (C, III (no benefit))
701

Recommendation Grading

Disclaimer

Overview

Title

Pacemaker Device and Mode Selection

Authoring Organizations

Publication Month/Year

August 1, 2012

Supplemental Implementation Tools

Document Type

Consensus

External Publication Status

Published

Country of Publication

US

Document Objectives

Should be used as a supplement to the published 2008 guidelines document, functioning as a guide to facilitate the selection of single- vs. dual-chamber devices for patients who already meet guidelines for pacemaker implantation

Inclusion Criteria

Female, Male, Adult, Older adult

Health Care Settings

Ambulatory, Hospital, Operating and recovery room

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Management

Diseases/Conditions (MeSH)

D001919 - Bradycardia, D054537 - Atrioventricular Block, D010138 - Pacemaker, Artificial

Keywords

pacemaker, sinus node dysfunction, AV block

Source Citation

HRS/ACCF Expert Consensus Statement on Pacemaker Device and Mode Selection
Anne M. Gillis, Andrea M. Russo, Kenneth A. Ellenbogen, Charles D. Swerdlow, Brian Olshansky, Sana M. Al-Khatib, John F. Beshai, Janet M. McComb, Jens Cosedis Nielsen, Jonathan M. Philpott, Win-Kuang Shen
J Am Coll Cardiol. 2012 Aug, 60 (7) 682-703.