MODES
DDD

-DDD Decreases AF not mortality (only proven in the DANISH study) by decreasing retrograde dissociation and
decreasing LAP
Healey J S et al Circulation 2006; 114:11-17 - Metanalysis

-CTOPP showed that DDD decreases AF by 1.2% / year ARR (NNT=9)
-MOST showed that DDD decreases AF by 11.5% / 3 years ARR (NNT=9)

-Cumulative VP < 40% was associated with event free survival of AF.
Sweeney et al Circulation 2003; 107:2932-7

-SAVE PACe showed that DDD with minimal VP vs. conventional DDD was associated with less AF
Sweeney NEJM 2007; 357: 1000-1008

-DAVID trial showed taht > 40% VP was associated with CHF

-Guidelines integrated > 40% VP indication for DDD

-Dual chamber was associated with 9% complications vs. VVI 3.8%

-DANPACE showed that AP alone was not good in terms of preventing AF
Nielsen J C Eur Heart J 2011;32:686-696

-AV search hysteresis extends AVD to 450 max in BOS devices. In the 400 range it starts to increase the
occurrence of AF

UK PACE is one of the few studies regarding indications in AVB cases.
UK PACE Toff NEJM 2005 353: 145-155

Proof that Pacemaker Syndrome does not develop with DDD
Castelnuovo 2005;9: III, XI-XIII: 1 - 246


GUIDELINES

SND

CLASS I INDICATION DDD
-SND and intact AVN conduction (decreases AF occurrence)

CLASS I DDD-R
Symptomatic chronotropic incompetence

CLASS IIb AAI for SND with intact AV conduction
CLASS IIb VVI for AVB

CLASS I (C) DDD in AVB
CLASS I (B) VVI alternative to DDD in AVB with clinical conditions (limited vascular access, comorbidities,
sendetariness....)
CLASS I (B) DDD>VVI in AVB with documented Pacemaker syndrome

AVB

CLASS IIa (C) VDD in normal sinus function with AVB (congenital heart block)
CLASS IIa (C) VVI post AVJ ablation or in anticipation of AVJ ablation for rate control of AF

CLASS III DDD in permanent AF

In jan 2013 CMS accepted HRS / ACC indications