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Europace Advance Access published online on September 16, 2009
Europace, doi:10.1093/europace/eup252
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org.

CLINICAL RESEARCH

Difference in percentage of ventricular pacing between two algorithms for minimizing ventricular pacing: results of the IDEAL RVP (Identify the Best Algorithm for Reducing Unnecessary Right Ventricular Pacing) study

Yoshimasa Murakami1,*, Naoya Tsuboi2, Yasuya Inden3, Yukihiko Yoshida4, Toyoaki Murohara3, Zenichi Ihara5 and Mitsuaki Takami5

1 Cardiovascular Center, Higashi Municipal Hospital, City of Nagoya, 1-2-23 Wakamizu, Chikusa-ku, Nagoya 464-8547, Japan; 2 Social Insurance Chukyo Hospital, Nagoya, Japan; 3 Nagoya University Graduate School of Medicine, Nagoya, Japan; 4 Nagoya Dai-ni Red Cross Hospital, Nagoya, Japan; 5 Medtronic Japan, Tokyo, Japan

Aims: Managed ventricular pacing (MVP) and Search AV+ are representative dual-chamber pacing algorithms for minimizing ventricular pacing (VP). This randomized, crossover study aimed to examine the difference in ability to reduce percentage of VP (%VP) between these two algorithms.

Methods and results: Symptomatic bradyarrhythmia patients implanted with a pacemaker equipped with both algorithms (Adapta DR, Medtronic) were enrolled. The %VPs of the patients during two periods were compared: 1 month operation of either one of the two algorithms for each period. All patients were categorized into subgroups according to the atrioventricular block (AVB) status at baseline: no AVB (nAVB), first-degree AVB (1AVB), second-degree AVB (2AVB), episodic third-degree AVB (e3AVB), and persistent third-degree AVB (p3AVB). Data were available from 127 patients for the analysis. For all patient subgroups, except for p3AVB category, the median %VPs were lower during the MVP operation than those during the Search AV+ (nAVB: 0.2 vs. 0.8%, P < 0.0001; 1AVB: 2.3 vs. 27.4%, P = 0.001; 2AVB: 16.4% vs. 91.9%, P = 0.0052; e3AVB: 37.7% vs. 92.7%, P = 0.0003).

Conclusion: Managed ventricular pacing algorithm, when compared with Search AV+, offers further %VP reduction in patients implanted with a dual-chamber pacemaker, except for patients diagnosed with persistent loss of atrioventricular conduction.

Key Words: Algorithm, Pacemaker, Minimizing ventricular pacing, Atrioventricular block

* Corresponding author. Tel: +81 52 721 7171, Fax: +81 52 721 1308, Email: yhyvilla{at}aol.com

Manuscript submitted 23 June 2009. Accepted after revision 11 August 2009.


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