Single-chamber versus dual-chamber pacing: real world data from the German national VIDEO project
Authors: Vogler J , Sommer P , Steven D , Meyer C , Pauschinger M , Kuniss M , Doll N , Zahn R , Brachmann J , Perings C , Lewalter T , Voigtlaender T , Schneider S , Senges J , Tilz R R 
Published: May 2024

Abstract

Background
Dual-chamber (DC) cardiac pacing is thought to offer a clinical benefit as compared to single-chamber (SC) cardiac pacing. With the introduction of leadless pacers and the recommendation for DC-pacing in sinus node dysfunction, the implantation rates of SC-pacemaker have markedly decreased. However, little is known from real word national healthcare data. The purpose of this VIDEO substudy is to analyze the German national healthcare situation with regards to SC- vs. DC-pacing.

Methods
German hospitals are obliged to provide a dataset including case data, diagnosis, operational and procedural codes to the Institute for hospital remuneration system (InEK) every year. The VIDEO project aims at analyzing these data to report real world data on patients undergoing Cardiac implantable electronic device (CIED) surgery in Germany. As of now, 22 German centers were contacted by the Institute for Myocardial Infarction Research (IHF). Ten centers provided their data from 2018 to 2023. Datasets from the remaining centers are pending. The project is supported by the German Heart Foundation.

Results
A total of 12,474 patients (35.6% females, mean age 71.2 ± 14.5 years) underwent CIED surgery at 10 centers in Germany. A SC-pacemaker was implanted in 1071 patients (group A), a DC-pacemaker in 6343 patients (group B) and other CIEDs including defibrillators in the remaining 5060 patients. Only a minority of the surgeries in both groups were revisions. The median patient age in group A was 81 years (IQR 77;85) compared to 78 years (IQR 70;83) in group B. Of the patients receiving a SC-pacemaker only 4.2% were adults between 40-64 years old compared to 13.4% in the DC-pacemaker group. Diabetes mellitus, chronic obstructive pulmonary disease and a heart failure were more common in group A (30.5% vs. 25.1%, 9.0 vs. 6.0%, 53.2% vs. 35.9%, p &lt;0.01). Atrial fibrillation was known in 942/1050 (89.7%) in patients receiving as SC-pacemaker and in 2589/6197 (42.4%) in those with a DC-pacemaker (p &lt; 0.01). The main indication for pacemaker implantation in both groups was atrioventricular block (41.5% vs. 69.5%, p &lt;0.01) followed by sinus node dysfunction (19.7% vs 27.6%, p &lt; 0.01). All patients were treated as inpatients. The median hospital stay in group A was significantly longer than in group B (8.0 (IQR 3.0; 16.0) vs. 6.0 (IQR 2.0; 13.0), p &lt; 0.01). Half of the patients in both groups were treated on an intensive care unit (ICU) (51.7% and 56.6%) with a median ICU stay of 2.8 (IQR 1.1;5.8) in group A and 2.3 (IQR 1.0;10.0) in Group B. The in-hospital mortality was higher in patients receiving a SC-pacemaker (2.6%) as compared to the DC-pacemaker group (1.6%).

Conclusion
In Germany, single-chamber pacemakers are implanted six times less common than dual-chamber pacemakers. Patients receiving SC-pacemakers are older, more likely to suffer from permanent atrial fibrillation and have a prolonged in-hospital stay.