When this happens, a single-chamber pacemaker should be used.When the pacemaker is fitted to these patients, it should be attached to the upper chamber of the heart.
The second is when the symptomatic bradycardia is caused by atrioventricular block and the patient has continuous atrial fibrillation (this is a rapid and irregular beating of the upper chamber of the heart).
When this happens a single-chamber pacemaker should be used, and it should be attached to the lower chamber of the heart.
But there are a number of special circumstances where dual-chamber pacemakers should not be used for symptomatic bradycardia.
The first of these circumstances is when the symptomatic bradycardia is caused by sick sinus syndrome, but the flow of electrical impulses between the upper and lower chambers of the patient's heart is normal.
For these patients, a single-chamber pacemaker should be used, and should be attached to the lower chamber of the heart.
The recommendations in this guidance represent the view of NICE, arrived at after careful consideration of the evidence available.Implantation Technique A cardiologist verified the suitability of the pacing mode in each case according to classic criteria and actively participated in threshold detection during implantation via the Medtronic 2098 programmable analyzer. Can chest roentgenogram predict the posture dependent changes of atrial sensing performance in patients with a VDD pacemaker? The implantation technique was decided by a cardiac surgeon experienced in this field, choosing the venous access route depending on the individual. Uncontrollable supraventricular arrhythmias were observed in 6.4% of patients. By the end of follow-up, 91.4% of patients were still on VDD pacing, while, in 8.3%, the pacemaker had to be reprogrammed to the VVI mode. Only 0.3% required atrial lead implantation for DDD pacing. VDD pacing: underevaluated, undervalued, and underused. Commissioners and/or providers have a responsibility to provide the funding required to enable the guidance to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution.