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

• Published in: Europace (London, England) Vol. 10; no. 3; pp. 314 - 320
• Main Authors: Albertsen, Andi E., Nielsen, Jens C., Poulsen, Steen H., Mortensen, Peter T., Pedersen, Anders K., Hansen, Peter S., Jensen, Henrik K., Egeblad, Henrik
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.03.2008; Oxford Publishing Limited (England)
• Subjects: Aged; Aged, 80 and over; Atrioventricular Block - diagnostic imaging; Atrioventricular Block - physiopathology; Atrioventricular Block - therapy; Cardiac Pacing, Artificial - methods; Echocardiography, Three-Dimensional; Electrocardiography; Female; Heart Atria - physiopathology; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Humans; Male; Natriuretic Peptide, Brain - blood; Pacemaker, Artificial; Peptide Fragments - blood; Stroke Volume - physiology; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - physiopathology; Ventricular Dysfunction, Left - therapy; BiV pacing; Heart failure; Tissue-Doppler echocardiography; Right ventricular pacing; Three-dimensional echocardiography; AV block
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/eun023

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.