Dataset Information

Chronic Apical and Nonapical Right Ventricular Pacing in Patients with High-Grade Atrioventricular Block: Results of the Right Pace Study.

ABSTRACT:

Objective

The aim of the study was to compare the two approaches to chronic right ventricular pacing currently adopted in clinical practice: right ventricular apical (RVA) and non-RVA pacing.

Background

Chronic RVA pacing is associated with an increased risk of atrial fibrillation, morbidity, and even mortality. Non-RVA pacing may yield more physiologic ventricular activation and provide potential long-term benefits and has recently been adopted as standard procedure at many implanting centers.

Methods

The Right Pace study was a multicenter, prospective, single-blind, nonrandomized trial involving 437 patients indicated for dual-chamber pacemaker implantation with a high percentage of RV pacing.

Results

RV lead-tip target location was the apex or the interventricular septum. RVA (274) and non-RVA patients (163) did not differ in baseline characteristics. During a median follow-up of 19 months (25th-75th percentiles, 13-25), 17 patients died. The rates of the primary outcome of death due to any cause or hospitalization for heart failure were comparable between the groups (log-rank test, p = 0.609), as were the rates of the composite of death due to any cause, hospitalization for heart failure, or an increase in left ventricular end-systolic volume ≥ 15% as compared with the baseline evaluation (secondary outcome, p = 0.703). After central adjudication of X-rays, comparison between adjudicated RVA (239 patients) and non-RVA (170 patients) confirmed the absence of difference in the rates of primary (p = 0.402) and secondary (p = 0.941) outcome.

Conclusions

In patients with indications for dual-chamber pacemaker who require a high percentage of ventricular stimulation, RVA or non-RVA pacing resulted in comparable outcomes. This study is registered with ClinicalTrials.gov (identifier: NCT01647490).

SUBMITTER: Muto C

PROVIDER: S-EPMC5987304 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Chronic Apical and Nonapical Right Ventricular Pacing in Patients with High-Grade Atrioventricular Block: Results of the Right Pace Study.

Muto Carmine C Calvi Valeria V Botto Giovanni Luca GL Pecora Domenico D Porcelli Daniele D Costa Alessandro A Ciaramitaro Gianfranco G Airò Farulla Riccardo R Rago Anna A Calvanese Raimondo R Baratto Marco Tullio MT Reggiani Albino A Giammaria Massimo M Patané Santina S Campari Monica M Valsecchi Sergio S Maglia Giampiero G

BioMed research international 20180522

<h4>Objective</h4>The aim of the study was to compare the two approaches to chronic right ventricular pacing currently adopted in clinical practice: right ventricular apical (RVA) and non-RVA pacing.<h4>Background</h4>Chronic RVA pacing is associated with an increased risk of atrial fibrillation, morbidity, and even mortality. Non-RVA pacing may yield more physiologic ventricular activation and provide potential long-term benefits and has recently been adopted as standard procedure at many impla ...[more]

PMID: 29951525

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Project description:Background: Left bundle branch area pacing (LBBAP) is a novel pacing modality with stable pacing parameters and a narrow-paced QRS duration. We compared heart failure (HF) hospitalization events and echocardiographic measures between LBBAP and right ventricular pacing (RVP) in patients with atrioventricular block (AVB). Methods and Results: This multicenter observational study prospectively recruited consecutive AVB patients requiring ventricular pacing in five centers if they received LBBAP or RVP and had left ventricular ejection fraction (LVEF) >50%. Data on electrocardiogram, pacing parameters, echocardiographic measurements, device complications, and clinical outcomes were collected at baseline and during follow-up. The primary outcome was first episode hospitalization for HF or upgrade to biventricular pacing. LBBAP was successful in 235 of 246 patients (95.5%), while 120 patients received RVP. During a mean of 11.4 ± 2.7 months of follow-up, the ventricular pacing burden was comparable (83.9 ± 35.1 vs. 85.7 ± 30.0%), while the mean LVEF differed significantly (62.6 ± 4.6 vs. 57.8 ± 11.4%) between the LBBAP and RVP groups. Patients with LBBAP had significantly lower occurrences of HF hospitalization and upgrading to biventricular pacing than patients with RVP (2.6 vs. 10.8%, P <0.001), and differences in primary outcome between LBBAP and RVP were mainly observed in patients with ventricular pacing >40% or with baseline LVEF <60%. The primary outcome was independently associated with LBBAP (adjusted HR 0.14, 95% CI: 0.04-0.55), previous myocardial infarction (adjusted HR 6.82, 95% CI: 1.23-37.5), and baseline LVEF (adjusted HR 0.91, 95% CI: 0.86-0.96). Conclusion: Permanent LBBAP might reduce the risk of HF hospitalization or upgrade to biventricular pacing compared with RVP in AVB patients requiring a high burden of ventricular pacing. Clinical Trial Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03851315; URL: http://www.chictr.org.cn; Unique Identifier: ChiCTR2100043296.

Project description:BackgroundLeft bundle branch area pacing (LBBAP) is a new technique for patients with atrioventricular block (AVB) and preserved left ventricular ejection fraction (LVEF), potentially offering better cardiac function than right ventricular pacing (RVP).MethodsWe searched databases and registries for studies that compared LBBAP with RVP in patients with AVB and preserved LVEF. We extracted data on various outcomes and pooled the effect estimates using random-effects models.ResultsOur meta-analysis included 14 studies (10 observational and 4 RCTs) involving 3062 patients with AVB. The analysis revealed that the QRS duration was significantly shorter in the LBBAP group compared to the RVP group [MD = -35.56 ms; 95% CI: (-39.27, -31.85), p < 0.00001]. Patients in the LBBAP group also exhibited a significant increase in left ventricular ejection fraction (LVEF) [MD = 5.48%; 95% CI: (4.07%, 6.89%), p < 0.00001], and a significant reduction in left ventricular end-diastolic diameter (LVEDD) compared to RVP [MD = -3.98 mm; 95% CI: (-5.88, -2.09 mm), p < 0.0001]. In terms of clinical outcomes, LBBAP was associated with a significantly lower risk of heart failure hospitalizations (HFHs) compared to RVP [OR = 0.26; 95% CI: (0.16, 0.44), p < 0.0001]. However, no significant differences were observed between the two groups in the implant success rate, pacing impedance, or pacing threshold. The RVP group demonstrated a significantly higher R-wave amplitude increase than the LBBAP group [MD = 0.85 mV; 95% CI: (0.23, 1.46), p = .007]. Lastly, there was no significant difference in the incidence of complications between the two groups [OR = 2.12; 95% CI: (0.29, 15.52), p = 0.46].ConclusionLBBAP outperforms RVP in several cardiac function indicators, suggesting it may be a superior pacing method for AVB patients with preserved LVEF. However, the small sample size in studies and the result in heterogeneity call for more research to validate these findings and assess LBBAP's long-term effects.

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Dataset Information

Chronic Apical and Nonapical Right Ventricular Pacing in Patients with High-Grade Atrioventricular Block: Results of the Right Pace Study.

Objective

Background

Methods

Results

Conclusions

Publications

Chronic Apical and Nonapical Right Ventricular Pacing in Patients with High-Grade Atrioventricular Block: Results of the Right Pace Study.

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