Upgrade to biventricular pacing in patients with conventional pacemakers and heart failure: a double-blind, randomized crossover study

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
Carl J HöijerJohan Brandt

Abstract

To investigate whether patients with previously implanted conventional pacemakers and severe heart failure benefit from an upgrade to a biventricular system. Study inclusion criteria were New York Heart Association (NYHA) classes III and IV, dominant paced rhythm, and no left bundle branch block in the pre-pacing ECG. Ten patients with pacemakers (four VVIR due to slow atrial fibrillation and six DDDR, of which four were due to high-degree atrioventricular block and two to sinus node disease) were upgraded to a biventricular pacing (BVP) system. The median duration of pacing before the upgrade was 5.7 years. Assessments of 6-min walk test, symptom score, brain natriuretic peptide (pro-BNP), and echocardiography were made pre-operatively. After a run-in period of 1 month in BVP following the upgrade, the patients were randomized to a 2-month period in either BVP or right ventricular pacing (RVP), followed by 2 months in the other mode, in a double-blind crossover fashion. After each period, the pre-operative measurements were repeated. After study completion, patients were asked to select their preferred period. The median 6-min walking distance was significantly longer in BVP (400 m) vs. RVP (315 m), P = 0.02. The symptom score...Continue Reading

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