Europace Advance Access published online on February 12, 2008
Europace, doi:10.1093/europace/eun023
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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
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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