Clinical implications of elective replacement indicator setting changes in patients with dual-chamber pacemaker devices

Kari A. Phillips, Shiva Ponamgi, Benjamin Mundell, Mykhaylo Krushelnytskyy, Zhuo Li, Robert Rea, Abhishek Deshmukh, Christopher McLeod, Raul E. Espinosa, Michael Osborn, Paul A. Friedman, Siva K. Mulpuru, Yong Mei Cha, Lori B. Neutzling, Thomas Munger, Krishna Kancharla, Samuel J. Asirvatham

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objective: This study sought to determine if single-chamber operation and/or loss of rate response (RR) during elective replacement indicator (ERI) in patients with dual-chamber pacemakers lead to increased symptom burden, healthcare utilization, and atrial fibrillation (AF). Background: Dual-chamber pacemakers often change from dual- to single-chamber pacing mode and/or lose RR functionality at ERI to preserve battery. Single-chamber pacing increases the incidence of heart failure, AF, and pacemaker syndrome suggesting these changes may be deleterious. Methods: A retrospective analysis of 700 patients was completed. Three comparisons were analyzed: Comparison 1: mode change and RR loss versus no change; Comparison 2: RR loss only versus no change; Comparison 3: mode change only versus no change (in patients with no RR programmed at baseline). Results: In Comparison 1, 121 (46%) patients with setting changes experienced symptoms (most often dyspnea and fatigue/exercise intolerance) versus 3 (4%) without setting changes (p <.0001). Similar results were noted in Comparisons 2 and 3 (p =.0016 and p =.0001, respectively). In Comparison 1, patients with setting change sought provider contact more than patients without setting changes (p =.0001). A significant difference was not noted in Comparison 2 or 3. Overall 14 (2%) patients were hospitalized, all of whom had setting changes. Conclusions: Setting changes at ERI including a change from dual- to single-chamber pacing and/or loss of RR results in a significantly increased symptom burden and increased healthcare utilization.

Original languageEnglish (US)
Pages (from-to)2704-2710
Number of pages7
JournalJournal of cardiovascular electrophysiology
Issue number10
StatePublished - Oct 1 2020


  • dual-chamber pacemaker
  • elective replacement indicator

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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