Key result
Minimizing right ventricular pacing significantly improved peak oxygen uptake compared to a fixed 150 ms AV delay (19.9 vs 14.2 ml/kg per min, P=0.0001) and preserved left ventricular function.
Why the study?
Does a pacemaker programming algorithm minimizing right ventricular pacing improve exercise capacity, BNP levels, and left ventricular function compared to a fixed 150 ms atrioventricular delay in patients with sinus node dysfunction?
RCT (n=31)
Randomized crossover
Does a pacemaker programming algorithm minimizing right ventricular pacing improve exercise capacity, BNP levels, and left ventricular function compared to a fixed 150 ms atrioventricular delay in patients with sinus node dysfunction?
Absolute Event Rate: 19.9% vs 14.2%
p-value: p=0.0001
In patients with sinus node dysfunction, pacemaker programming that minimizes right ventricular pacing improves exercise capacity, reduces BNP, and preserves left ventricular function compared to fixed atrioventricular delay.
Supports minimizing RV pacing in sinus node dysfunction; extends RCT evidence for physiologic pacemaker programming.
INTRODUCTION: Right ventricular pacing (RVP) causes ventricular desynchronization and may lead to the development of heart failure (HF). Prolongation of atrioventricular delay (AVD) in DDDR pacemakers reduces unnecessary RV stimulation. The aim of the study was to verify the influence of RVP reduction on HF symptoms. METHODS: The study comprised 31 patients (17 men, mean age: 71.6 ± 8 yrs) with DDDR pacemaker implanted due to sinus node dysfunction (SND). At baseline, 28 patients did not present any symptoms of HF. Three patients were in NYHA class II. Patients were randomized either to 150 ms AVD or to minimizing right ventricular pacing (MRVP). Crossing over to the alternate mode took place after 4 months. Cardiopulmonary exercise test (CPX), echocardiography (ECHO) and BNP measurements were done before pacemaker implantation, after 4 and 8 months. RESULTS: The percentage of RVP was significantly higher in 150 ms AVD than in MRVP: 81.7 ± 22.6 versus 14.2±20.5%, P < 0.0001. Patients with 150 ms mode had worse CPX parameters than those with MRVP mode: peak oxygen uptake was 14.2±4.3 versus 19.9±6.3 ml/kg per min, P = 0.0001, higher BNP concentrations: 72.3±48.3 versus 49.4±43.9 pg/ml, P = 0.001 and worse left ventricle [LV] function: ejection fraction: 53.2±6.7 versus 57.3±5.5%, P < 0.0001; LV diastolic diameter: 4.86±0.52 versus 4.66±0.5 cm, P < 0.01. CONCLUSION: Predominant RVP in patients without symptoms of HF at baseline may be responsible for worse performance in cardiopulmonary exercise test, higher BNP concentrations and impairment of LV function. Specific DDDR pacemaker programming promotes intrinsic AV conduction and may prevent the development of pacing-induced HF.
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Chwyczko et al. (2013) conducted an RCT in Sinus node dysfunction (n=31). Minimizing right ventricular pacing (MRVP) vs. 150 ms atrioventricular delay (AVD) was evaluated on Peak oxygen uptake (ml/kg per min) (p=0.0001). Minimizing right ventricular pacing significantly improved peak oxygen uptake compared to a fixed 150 ms AV delay (19.9 vs 14.2 ml/kg per min, P=0.0001) and preserved left ventricular function.
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