Observational studyEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2026
Adverse outcomes due to atrioventricular synchrony loss induced by temporary VVI pacing in patients with pre-existing DDD stimulation: insights from a device recall scenario.
Observational study in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
aimsTemporary reprogramming of dual-chamber (DDD) pacemakers to non-synchronous ventricular modes (VVI/VVIR) may be required in selected clinical scenarios, but short-term consequences of abrupt atrioventricular (AV) synchrony loss remain incompletely characterized.Leveraging a unique natural experiment, this study aimed to quantify the clinical and echocardiographic consequences of temporary VVI/VVIR pacing in patients in sinus rhythm chronically adapted to DDD stimulation. METHODS AND
resultsIn this prospective observational study, 93 patients (79.9 ± 16.0 years; 63.4% AV block) with recalled DDD pacemakers were reprogrammed to VVI/VVIR for 6 months, followed by DDD restoration. Serial assessments included echocardiography, BNP, and 6-min walk test. Primary endpoints were changes in left ventricular ejection fraction (LVEF) and heart failure (HF) hospitalizations; secondary endpoints included echocardiographic remodelling parameters, functional capacity, quality of life, and atrial fibrillation. Clinical events were tracked for 12 months. Ventricular pacing remained >88% throughout. During the VVI/VVIR period, HF hospitalizations increased compared with the subsequent DDD restoration period (22.6% vs. 6.7%, P < 0.001). This was accompanied by adverse echocardiographic remodelling, a decline in LVEF from 57.3% to 53.0% (P < 0.001), and a marked BNP increase from 155 to 260 pg/mL (P < 0.001). After DDD restoration, clinical and structural recovery was incomplete: LVEF improved to 54.8% and BNP decreased to 210 pg/mL, but both remained significantly worse than baseline (P < 0.05).
conclusionTemporary loss of AV synchrony in chronically DDD-paced patients was associated with rapid, severe, and only partially reversible clinical and echocardiographic deterioration. These findings underscore that continuous AV synchrony is a critical determinant of clinical stability.
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