Dual Chamber Pacemaker Indications

The physicians rationale for choosing a dual-chamber pacemaker rather than a single. Indications for dual-chamber DDD pacing in implantable cardioverter-defibrillator patients.

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The indications for pacemaker therapy have expanded in the past 45 years and now include the treatment of bradyarrhythmias and the electrical therapy of tachyarrhythmias certain types of syncope.

Dual chamber pacemaker indications. The National Institute for Health and Care Excellence NICE recommends that dual-chamber pacemakers can be used to treat symptomatic bradycardia in people with sick sinus syndrome AV block or both but identified a number of circumstances where dual-chamber pacemakers should not be used for symptomatic bradycardia. Pacemakers or AAI and AAIR atrial pacemakers. 23 February 2005 Last updated.

On-demand programming has significant advantages including prolonging battery life and avoiding unnecessary pacing especially in the ventricle. The first-generation ICD with limited shock capability alone. Dual chamber pacemakers have an additional lead positioned on the atrium thus sensing and pacing both chambers ie.

Dual-chamber pacemakers can be reprogrammed in a single-chamber mode as well. An abnormal heartbeat is called an arrhythmia. Members of the consensus group said dual-chamber pacing may be beneficial for patients with hypersensitive carotid sinus syndrome and neurocardiogenic syncope but.

When the record does not support the medical necessity of the dual chamber pacemaker the services are denied. A pacemaker or implantable cardioverter defibrillator ICD is needed when something disrupts this process and causes an abnormal heartbeat. Dual-chamber pacemaker implantation in patients with a clear contraindication such as chronic atrial fibrillation.

The following indications are covered for implanted permanent single chamber or dual chamber cardiac pacemakers. For example if the patient develops permanent atrial fibrillation. Here are some of the most common causes of arrhythmias.

Dual-chamber ICDs are indicated for patients who require an ICD in addition to cardiac pacing for sinus node andor AV node conduction disease either due to an intrinsic etiology or antiarrhythmic therapy. It has been suggested that less sophisticated devices eg single-chamber ventricular pacemakers or nonrate-responsive pacemakers should be considered for elderly patients who require pacing. The NCD lists contraindications for dual-chamber pacemakers.

It works by generating electric impulses that are sent to the right atrium and right ventricle of the heart thereby stimulating contractions and allowing the two chambers to maintain rhythm. Dual chamber pacing or single chamber atrial pacing physiologic pacing is believed to have an advantage over single chamber ventricular pacing in that it resembles cardiac physiology more closely by maintaining atrioventricular AV synchrony and dominance of the sinus node which in turn may reduce cardiovascular morbidity and mortality thus contributing to patient survival and quality of life. New technologic development of implantable cardioverter-defibrillators ICDs keeps up with the exponential increase of their use for primary and secondary prevention of sudden cardiac death.

1 Some patients with sinus node dysfunction and paroxysmal AF for example may develop atrioventricular block in the future as a result of natural progression of disease drug therapy or catheter ablation. Electrostimulation is usually inhibited in single-chamber pacemakers when a spontaneous depolarisation occurs whilst this may either inhibit or trigger pacing in. Documented non-reversible symptomatic bradycardia due to sinus node dysfunction and Documented non-reversible symptomatic bradycardia due to second degree andor third degree atrioventricular block.

A dual-chamber pacemaker is small electrical device that can be implanted into the chest to regulate the heartbeat. However a large retrospective analysis of elderly Medicare patients suggested that dual-chamber pacing is associated with improved survival compared with ventricular pacing even after correction for confounding variables. Thus current guidelines state that it is reasonable to select a pacemaker with more extensive capabilities than needed at the time of implantation but that may prove useful in the future.

Technology appraisal guidance TA88 Published date. Dualchamber pacemakers for symptomatic bradycardia due to sick sinus syndrome andor atrioventricular block. The AV node relays the pulse to the 2 lower chambers of the heart the ventricles.

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