From the Guidelines
For junctional rhythm requiring pacing, a dual-chamber pacemaker with two leads is typically recommended, as it allows for both sensing and pacing of both chambers, helping maintain proper atrioventricular synchrony 1. This dual-chamber configuration (also called DDD pacing) includes one lead placed in the right atrium and another in the right ventricle. The importance of this configuration lies in its ability to restore proper timing between atrial and ventricular contractions, which improves cardiac output and hemodynamics compared to the native junctional rhythm or single-chamber pacing. Some key points to consider in the selection of a pacemaker for junctional rhythm include:
- The need to maintain atrioventricular synchrony, which is crucial for optimal cardiac function
- The potential for future development of atrial fibrillation or other conditions that might affect pacemaker function
- The benefits of dual-chamber pacing in improving symptoms and quality of life for patients with junctional rhythm In contrast to dual-chamber pacemakers, single-lead systems, such as VDD pacemakers, have limited use due to concerns about the degradation of atrial sensing ability over time and the potential need for atrial pacing if sinus node dysfunction develops 1. However, these systems may have a role in specific patient populations, such as younger patients with congenital heart block who may require multiple system revisions over their lifetime. Ultimately, the choice of pacemaker should be individualized based on the patient's specific needs and clinical characteristics, with the goal of improving morbidity, mortality, and quality of life. Key considerations in pacemaker selection include:
- Patient age and expected lifespan
- Underlying cardiac condition and potential for future complications
- Presence of other medical conditions that may affect pacemaker function or patient outcomes
- Patient preferences and values regarding pacemaker therapy.
From the Research
Pacemaker Leads for Junctional Rhythm
- The number of leads for a pacemaker in junctional rhythm is typically 2, with one lead in the right atrium and one in the right ventricle, as seen in dual-chamber pacemaker systems 2, 3, 4.
- Dual-chamber leadless pacemaker systems have been designed to provide atrioventricular synchronous pacing using wireless communication between the atrial and ventricular leads 2, 4, 5.
- These systems have been shown to be safe and effective in maintaining atrioventricular synchrony across various postures and activities 5.
- The use of dual-chamber pacemakers can help prevent pacemaker syndrome and functional atrial undersensing in patients with first-degree atrioventricular block 6.
- Epicardial pacing systems with dual-chamber leads can be implanted using a minimally invasive subxyphoid approach, providing an alternative to transvenous pacemaker systems 3.