The implantation of a VDD system is comparable to that of a VVI system, but its management is associated with typical complications of dual chamber pacing. In 35 patients with symptomatic AV block and normal sinus node function, two different VDD pacing systems were implanted. Most of the complications described and their mode of resolution were common to VDD and DDD pacing; however, the VDD system eliminated the need for two separate leads. We, therefore, favor single lead VDD pacing in the treatment of complete AV block with normal sinus node function.