Optimizing Pacemaker Longevity with Pacing Mode and Settings Programming: Results from a Pacemaker Multicenter Registry

Background: This study aimed to describe the influence on dual-chamber devices' expected longevity of devices' settings. Methods: Data from patients implanted with dual chamber devices (Symphony (TM), SORIN CRM SAS, Clamart, France) from 2003 to 2006 were collected in registries. Programmer files were retrieved: device-estimated longevity, assessed through algorithm prediction, was analyzed according to device settings. Results: One thousand sixty-eight recipients of dual chamber pacemaker in sinus rhythm (75.3 +/- 11.1 years, 54.5% male, ventricular block 30%, brady-tachy syndrome 21%, and sinus node dysfunction 49%) were followed up to 14.2 +/- 12.1 months (ranging from first quartile Q1: 2.9 months to fourth quartile Q4: 49.3 months) after implantation. DDD with automatic mode conversion and minimized ventricular pacing (SafeR) modes were programmed in 34.3%, 2.9%, and 62.8% of the patients, respectively. The mean total longevity estimated by the device was 134.1 +/- 31.5 months (11.2 +/- 2.6 years). Significant increase in longevity was observed in devices undergoing at least one reprogramming (134.4 +/- 31.4 months) versus device presenting no reprogramming (103.4 +/- 32.3 months, P = 0.0005). The parameters associated with the major increase in mean longevity were the mode (mean longevity increase of + 23.9 months in SafeR as compared to DDD mode, P < 0.0001) and the atrial (A) and ventricular (V) amplitudes (mean longevity increase of + 29.6 and + 26.9 months for a decrease of less than 1V in A and V outputs respectively, P < 0.0001). Conclusion: This study provides information on dual chamber pacemakers' longevity and highlights the impact of devices' reprogramming on expected longevities. (PACE 2012; 35: 403-408)