Dual-chamber pacing confers better myocardial performance and improves clinical outcomes compared to single-chamber pacing.

The deleterious effects of long term right ventricular pacing are increasingly being recognized today. Current clinical practice favors the implantation of dual-chamber permanent pacemaker which maintains atrioventricular synchrony and is associated with better quality of life. However, despite the popular belief and common sense surrounding the superiority of dual-chamber pacing over single chamber pacing, the same has never been conclusively verified in clinical trials. Some observational evidence however, does exists which supports the improved cardiac hemodynamics, lower the rate of atrial fibrillation, heart failure and stroke in dual-chamber pacing compared to single-chamber pacing. In the index study by Haque et al, right ventricular pacing, particularly in ventricular paced, ventricular sensed, inhibited response and rate responsive pacemaker adversely impacted the left ventricular functions over 9-months compared to dual pacing, dual sensing, dual responsive and rate responsive pacemaker. Although there are key limitations of this study, these findings does support a growing body of evidence reinstating the superiority of dual chamber pacing compared to single chamber pacing.