{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T02:27:45Z","timestamp":1777861665634,"version":"3.51.4"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T00:00:00Z","timestamp":1775606400000},"content-version":"vor","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Temporary reprogramming of dual-chamber (DDD) pacemakers to non-synchronous ventricular modes (VVI\/VVIR) may be required in selected clinical scenarios, but short-term consequences of abrupt atrioventricular (AV) synchrony loss remain incompletely characterized.<\/jats:p>\n                    <jats:p>Leveraging a unique natural experiment, this study aimed to quantify the clinical and echocardiographic consequences of temporary VVI\/VVIR pacing in patients in sinus rhythm chronically adapted to DDD stimulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>In this prospective observational study, 93 patients (79.9 \u00b1 16.0 years; 63.4% AV block) with recalled DDD pacemakers were reprogrammed to VVI\/VVIR for 6 months, followed by DDD restoration. Serial assessments included echocardiography, BNP, and 6-min walk test. Primary endpoints were changes in left ventricular ejection fraction (LVEF) and heart failure (HF) hospitalizations; secondary endpoints included echocardiographic remodelling parameters, functional capacity, quality of life, and atrial fibrillation. Clinical events were tracked for 12 months. Ventricular pacing remained &amp;gt;88% throughout. During the VVI\/VVIR period, HF hospitalizations increased compared with the subsequent DDD restoration period (22.6% vs. 6.7%, P &amp;lt; 0.001). This was accompanied by adverse echocardiographic remodelling, a decline in LVEF from 57.3% to 53.0% (P &amp;lt; 0.001), and a marked BNP increase from 155 to 260\u2005pg\/mL (P &amp;lt; 0.001). After DDD restoration, clinical and structural recovery was incomplete: LVEF improved to 54.8% and BNP decreased to 210\u2005pg\/mL, but both remained significantly worse than baseline (P &amp;lt; 0.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Temporary loss of AV synchrony in chronically DDD-paced patients was associated with rapid, severe, and only partially reversible clinical and echocardiographic deterioration. These findings underscore that continuous AV synchrony is a critical determinant of clinical stability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/europace\/euag068","type":"journal-article","created":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T11:40:36Z","timestamp":1775302836000},"source":"Crossref","is-referenced-by-count":0,"title":["Adverse outcomes due to atrioventricular synchrony loss induced by temporary VVI pacing in patients with pre-existing DDD stimulation: insights from a device recall scenario"],"prefix":"10.1093","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8774-2127","authenticated-orcid":false,"given":"Cristian","family":"Martignani","sequence":"first","affiliation":[{"name":"Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna , Via Massarenti 9, Bologna 40138 ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1227-5787","authenticated-orcid":false,"given":"Giulia","family":"Massaro","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Department of Medical and Surgical Sciences, University of Bologna , Bologna ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8452-7405","authenticated-orcid":false,"given":"Alberto","family":"Spadotto","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Department of Medical and Surgical Sciences, University of Bologna , Bologna ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8437-0222","authenticated-orcid":false,"given":"Lorenzo","family":"Bartoli","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Department of Medical and Surgical Sciences, University of Bologna , Bologna ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1484-1886","authenticated-orcid":false,"given":"Andrea","family":"Angeletti","sequence":"additional","affiliation":[{"name":"Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna , Via Massarenti 9, Bologna 40138 ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3617-2739","authenticated-orcid":false,"given":"Matteo","family":"Ziacchi","sequence":"additional","affiliation":[{"name":"Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna , Via Massarenti 9, Bologna 40138 ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3823-3809","authenticated-orcid":false,"given":"Igor","family":"Diemberger","sequence":"additional","affiliation":[{"name":"Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna , Via Massarenti 9, Bologna 40138 ,","place":["Italy"]},{"name":"Cardiology Unit, Department of Medical and Surgical Sciences, University of Bologna , Bologna ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4590-8584","authenticated-orcid":false,"given":"Mauro","family":"Biffi","sequence":"additional","affiliation":[{"name":"Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna , Via Massarenti 9, Bologna 40138 ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,4,7]]},"reference":[{"key":"2026043000465321600_euag068-B1","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/j.jacc.2016.10.064","article-title":"Advances and future directions in cardiac pacemakers: part 2 of a 2-part series","volume":"69","author":"Madhavan","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"2026043000465321600_euag068-B2","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.jacc.2016.10.061","article-title":"Cardiac pacemakers: function, troubleshooting, and management: part 1 of a 2-part series","volume":"69","author":"Mulpuru","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"2026043000465321600_euag068-B3","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1046\/j.1460-9592.2002.00260.x","article-title":"The revised NASPE\/BPEG generic code for antibradycardia, adaptive-rate, and multisite pacing. 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