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Heart Rhythm. 2014 Jun;11(6):992-1000. doi: 10.1016/j.hrthm.2014.01.011. Epub 2014 Jan 11.

Managed ventricular pacing compared with conventional dual-chamber pacing for elective replacement in chronically paced patients: results of the Prefer for Elective Replacement Managed Ventricular Pacing randomized study.

Author information

1
S. Anna Hospital, Como, Italy. Electronic address: gluca.botto@gmail.com.
2
San Filippo Neri Hospital, Rome, Italy.
3
Hospital General de Ciudad, Ciudad Real, Spain.
4
Aarhus University Hospital, Skejby, Aarhus N, Denmark.
5
Cliniques Universitaires UCL de Mont-Godinne, Yvoir, Belgium.
6
Centre Cardiologique du Nord, Saint-Denis, France.
7
Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
8
Policlinico Umberto I, Rome, Italy.
9
Presidio Ospedaliero di Montebelluna, Montebelluna, Italy.
10
Medtronic Bakken Research Center, Maastricht, The Netherlands.
11
Fakultni nemocnice Brno Bohunice, Brno, Czech Republic.

Abstract

BACKGROUND:

Several studies have shown that unnecessary right ventricular pacing has detrimental effects.

OBJECTIVE:

To evaluate whether minimization of ventricular pacing as compared with standard dual-chamber pacing (DDD) improves clinical outcomes in patients referred for pacemaker or implantable cardioverter-defibrillator (ICD) replacement.

METHODS:

In an international single-blind, multicenter, randomized controlled trial, we compared DDD with managed ventricular pacing (MVP), a pacing mode developed to minimize ventricular pacing by promoting intrinsic atrioventricular conduction. We included patients referred for device replacement with >40% ventricular pacing, no cardiac resynchronization therapy upgrade indication, no permanent atrial fibrillation (AF), and no permanent complete atrioventricular block. Follow-up was for 2 years. The primary end point was cardiovascular hospitalization. The intention-to-treat analysis was performed by using Kaplan-Meier method and the log-rank test.

RESULTS:

We randomized 605 patients (556 referred for pacemaker and 49 referred for ICD replacement; mean age 75 ± 11 years; 365 [60%] men, at 7.7 ± 3.3 years from first device implantation) to MVP (n = 299) or DDD (n = 306). We found no significant differences in the primary end point cardiovascular hospitalization (MVP: 16.3% vs DDD: 14.5%; P = .72) and the secondary end point persistent AF (MVP: 15.4% vs DDD: 11.2%; P = .08), permanent AF (MVP: 4.1% vs DDD: 3.1%; P = .44), and composite of death and cardiovascular hospitalization (MVP: 23.9% vs DDD: 20.2%; P = .48). MVP reduced right ventricular pacing (median 5% vs 86%; Wilcoxon, P < .0001) as compared with DDD.

CONCLUSIONS:

In patients referred for pacemaker and ICD replacement with clinically well-tolerated long-term exposure to >40% ventricular pacing in the ventricle, a strategy to minimize ventricular pacing is not superior to standard DDD in reducing incidence of cardiovascular hospitalizations.

KEYWORDS:

Cardiac pacing; Dual-chamber pacing; Managed ventricular pacing; Outcomes; Randomized controlled trial

PMID:
24418164
DOI:
10.1016/j.hrthm.2014.01.011
[Indexed for MEDLINE]
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