Key result
Minimizing RVP via prolonged AV delay fails to improve peak oxygen consumption versus standard pacing.
Why the study?
Does dual-chamber minimal ventricular pacing improve exercise capacity, cardiac function, and quality of life compared to conventional dual-chamber pacing in patients with sinus node disease and prolonged PQ interval?
RCT (n=50)
Randomized crossover
No
Does dual-chamber minimal ventricular pacing improve exercise capacity, cardiac function, and quality of life compared to conventional dual-chamber pacing in patients with sinus node disease and prolonged PQ interval?
In patients with sinus node disease and prolonged PQ interval, minimizing right ventricular pacing via prolonged AV delay did not significantly alter exercise capacity, cardiac function, or quality of life compared to conventional dual-chamber pacing.
No exercise benefit from prolonged AV delay; challenges rationale for minimizing ventricular pacing in sinus node disease.
BACKGROUND: Several clinical and experimental studies have shown that unnecessary right ventricular pacing in sinus node disease can be detrimental. Inter- and intra-ventricular asynchrony imposed by right ventricular pacing may cause reduction in contractility and relaxation of left ventricle, worsening mitral regurgitation, regional redistribution of myocardial perfusion and oxygen consumption, and asymmetrical hypertrophy of left ventricular wall. In some patients, sinus node disease coexists with impaired atrioventricular conduction. The optimal pacing mode in this population is not determined. Minimizing right ventricular pacing can preserve inter- and intra-ventricular synchrony. On the other hand, longer atrioventricular delay may cause atrioventricular asynchrony. The aim of this study was to prospectively assess the impact of minimizing right ventricular pacing in patients with DDD pacemaker implanted for sinus node disease and prolonged PQ interval on exercise capacity, cardiac function and quality of life. METHODS: The study enrolled 50 consecutive patients with prolonged PQ interval who were implanted with DDD pacemaker because of sinus node disease. Each patient was treated alternately with 2 pacing modes in random order for 4-month periods: conventional dualchamber pacing and dual-chamber minimal ventricular pacing (prolonged atrioventricular delay). At the end of each phase the following tests were performed: cardiopulmonary exercise testing, echocardiographic evaluation and quality of life assessment (SF36). RESULTS: There was no significant relationship between pacing mode and cardiopulmonary parameters, echocardiographic parameters and quality of life. CONCLUSIONS: Sequential atrioventricular pacing may be a reasonable choice for treating patients with sinus node disease and prolonged PQ interval.
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Krzyżanowski et al. (2014) conducted an RCT in Sinus node disease with prolonged PQ interval (n=50). Minimized ventricular pacing (prolonged atrioventricular delay) vs. Conventional dual-chamber pacing (standard AV delay) was evaluated on Peak oxygen consumption (mL/kg/min) (p=0.26). Minimizing right ventricular pacing by prolonging atrioventricular delay did not significantly improve peak oxygen consumption compared to standard pacing in patients with sinus node disease and prolonged PQ interval.
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