Key result
Low right ventricular pacing (<30%) was associated with significantly more favorable overall survival in ICD patients compared to high pacing (OR 0.34; 95% CI 0.13-0.91; P=0.03).
Why the study?
Does high right ventricular pacing (≥30%) reduce overall survival or increase ventricular tachyarrhythmias in routine ICD patients with restrictively programmed pacing?
Observational (n=213)
Does high right ventricular pacing (≥30%) reduce overall survival or increase ventricular tachyarrhythmias in routine ICD patients with restrictively programmed pacing?
Odds Ratio: 0.34 (95% CI 0.13–0.91)
p-value: p=0.03
Frequent right ventricular pacing (≥30%) is associated with impaired overall survival in ICD patients, even with conservative pacing settings, though it does not increase the incidence of ventricular tachyarrhythmias.
Minimizing RV pacing may confer survival benefit in ICD patients; leaves open causality and optimal thresholds for randomized confirmation.
AIMS: Data from previous defibrillator studies raised concern about right ventricular pacing (RVP) promoting heart failure progression and mortality in implantable cardioverter/defibrillator (ICD) patients. The present observational study re-examined the association of RVP, survival, and ventricular tachyarrhythmias/ventricular fibrillation (VT/VF) in routine ICD patients with restrictively programmed pacing. METHODS AND RESULTS: In 213 ICD patients [183 men, left ventricular ejection fraction (LVEF) 37 +/- 15%, follow-up 37 +/- 18 months, no advanced atrioventricular (AV) block], the RVP proportion, survival, and the time to a first appropriate VT/VF episode were assessed. Electrograms were validated and the overall survival was determined. The RVP prevalence was dichotomized at > or = 30% (high RVP) vs. <30% (low RVP). High RVP (RVP 94%, n = 24) and low RVP (RVP 0%, n = 189) patients had similar LVEF, underlying heart disease, ICD indication, and medication. Multivariate Cox regression showed no difference in survival without appropriate VT/VF treatment [odds ratio (OR): 0.92, 95% confidence interval (CI): 0.41-2.04, P = 0.83]. Overall survival was significantly more favourable in low RVP patients (OR: 0.34, CI: 0.13-0.91, P = 0.03). CONCLUSION: Frequent RVP is associated with impaired survival in ICD patients despite conservative pacing settings. Implantable cardioverter/defibrillator patients requiring concomitant bradycardia pacing should be cared for with particular attention to clinical worsening. Right ventricular pacing prevention and alternative modalities of ventricular pacing need prospective evaluation.
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Stockburger et al. (2009) conducted an observational in Implantable cardioverter/defibrillator (ICD) patients (n=213). High right ventricular pacing (≥30%) vs. Low right ventricular pacing (<30%) was evaluated on Overall survival (OR 0.34, 95% CI 0.13-0.91, p=0.03). Low right ventricular pacing (<30%) was associated with significantly more favorable overall survival in ICD patients compared to high pacing (OR 0.34; 95% CI 0.13-0.91; P=0.03).
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