Key result
AV hysteresis pacing is linked to ~58% fewer heart failure hospitalizations vs fixed AV delays.
Why the study?
In bradycardia patients treated with dual-chamber pacing, it was unclear whether pacing with AV delay management via AV hysteresis reduces unnecessary ventricular pacing percentage and improves clinical outcomes compared with standard pacing.
Does dual-chamber pacing with AV delay management via AV hysteresis reduce heart failure hospitalizations, persistent atrial fibrillation, and cardiac death in bradycardia patients compared to standard pacing with fixed AV delays?
Observational (n=2,592)
Yes
Does dual-chamber pacing with AV delay management via AV hysteresis reduce heart failure hospitalizations, persistent atrial fibrillation, and cardiac death in bradycardia patients compared to standard pacing with fixed AV delays?
Effect estimate: RRR 57.5%
Absolute Event Rate: 1.3% vs 3.1%
p-value: p=0.002
In patients requiring dual-chamber pacing, minimizing ventricular pacing using AV hysteresis is associated with significantly reduced 1-year incidences of heart failure hospitalizations and persistent atrial fibrillation.
Supports AV hysteresis pacing to lower HF hospitalizations; hypothesis-generating and requires randomized confirmation.
AIMS: In bradycardia patients treated with dual-chamber pacing, we aimed to evaluate whether pacing with atrioventricular (AV) delay management [AV hysteresis (AVH)], compared with standard pacing with fixed AV delays, reduces unnecessary ventricular pacing percentage (VPP) and is associated with better clinical outcomes. Main study endpoints were the incidence of heart failure hospitalizations (HFH), persistent atrial fibrillation (AF), and cardiac death. METHODS AND RESULTS: Data from two identical prospective observational studies, BRADYCARE I in the USA and BRADYCARE II in Europe, Africa, and Asia, were pooled. Overall, 2592 patients (75 ± 10 years, 45.1% female, 50% with AVH) had complete clinical and device data at 1-year follow-up and were analysed. Primary pacing indication was sinus node disease (SND) in 1177 (45.4%), AV block (AVB) in 974 (37.6%), and other indications in 441 (17.0%) patients. Pacing with AVH, compared with standard pacing, was associated with a lower 1-year incidence of HFH [1.3% vs. 3.1%, relative risk reduction (RRR) 57.5%, P = 0.002] and of persistent AF (5.3% vs. 7.7%, RRR = 31.1%, P = 0.028). Cardiac mortality was not different between groups (1.0% vs. 1.4%, RRR = 27.8%, P = 0.366). Pacing with AVH, compared with standard pacing, was associated with a lower (P < 0.001) median VPP in all patients (7% vs. 75%), in SND (3% vs. 44%), in AVB (25% vs. 98%), and in patients with other pacing indications (3% vs. 47%). CONCLUSION: Cardiac pacing with AV delay management via AVH is associated with reduced 1-year incidence of HFH and persistent AF, most likely due to a reduction in VPP compared to standard pacing.
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Arnold et al. (2023) conducted an observational in Bradycardia requiring dual-chamber pacing (n=2,592). Atrioventricular (AV) delay management via AV hysteresis (AVH) vs. Standard pacing with fixed AV delays was evaluated on Incidence of heart failure hospitalizations at 1 year (RRR 57.5%, p=0.002). Pacing with atrioventricular hysteresis was associated with a 57.5% relative risk reduction in 1-year heart failure hospitalizations compared to standard pacing with fixed AV delays.
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