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Europace Advance Access originally published online on February 12, 2008
Europace 2008 10(3):314-320; doi:10.1093/europace/eun023
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

PACING

Biventricular pacing preserves left ventricular performance in patients with high-grade atrio-ventricular block: a randomized comparison with DDD(R) pacing in 50 consecutive patients

Andi E. Albertsen*, Jens C. Nielsen, Steen H. Poulsen, Peter T. Mortensen, Anders K. Pedersen, Peter S. Hansen, Henrik K. Jensen and Henrik Egeblad

Department of Cardiology, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, DK-8200 Aarhus N, Denmark

Aims: We aimed to investigate whether biventricular (BiV) pacing minimizes left ventricular (LV) dyssynchrony and preserves LV ejection fraction (LVEF) as compared with standard dual-chamber DDD(R) pacing in consecutive patients with high-grade atrio-ventricular (AV) block.

Methods and results: Fifty patients were randomized to DDD(R) pacing or BiV pacing. LVEF was measured using three-dimensional echocardiography. Tissue-Doppler imaging was used to quantify LV dyssynchrony in terms of number of segments with delayed longitudinal contraction (DLC). LVEF was not different between groups after 12 months (P = 0.18). In the DDD(R) group LVEF decreased significantly from 59.7(57.4–61.4)% at baseline to 57.2(52.1–60.6)% at 12 months of follow-up (P = 0.03), whereas LVEF remained unchanged in the BiV group [58.9(47.1–61.7)% at baseline vs. 60.1(55.2–63.3)% after 12 months (P = 0.15)]. Dyssynchrony was more prominent in the DDD(R) group than in the BiV group at baseline (2.2 ± 2.2 vs. 1.4 ± 1.3 segments with DLC per patient, P = 0.10); and at 12 month follow-up (1.8 ± 1.9 vs. 0.8 ± 0.9 segments with DLC per patient, P = 0.02). NT-proBNP was unchanged in the DDD(R) group during follow-up (122 ± 178 pmol/L vs. 91 ± 166 pmol/L, NS) but decreased significantly in the BiV-group (from 198 ± 505 pmol/L to 86 ± 95 pmol/L after 12 months, P = 0.02).

Conclusion: BiV pacing minimizes LV dyssynchrony, preserves LV function, and reduces NT-proBNP in contrast to DDD(R) pacing in patients with high-grade AV block.

Key Words: Right ventricular pacing, BiV pacing, AV block, Heart failure, Three-dimensional echocardiography, Tissue-Doppler echocardiography

* Corresponding author. Tel: +45 89 49 55 66; fax: +45 89 49 60 09.E-mail address: andieie{at}gmail.com

Manuscript submitted 26 August 2007. Accepted after revision 12 January 2008.


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