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Effect of right ventricular pacing lead site on left ventricular function in patients with high-grade atrioventricular block: results of the Protect-Pace study

Citation

Kaye, GC and Linker, NJ and Marwick, TH and Pollock, L and Graham, L and Pouliot, E and Poloniecki, J and Gammage, M, on behalf of the Protect-Pace trial investigators, Effect of right ventricular pacing lead site on left ventricular function in patients with high-grade atrioventricular block: results of the Protect-Pace study, European Heart Journal, 36 pp. 856-862. ISSN 1522-9645 (2015) [Refereed Article]

Copyright Statement

Copyright 2014 The Author

DOI: doi:10.1093/eurheartj/ehu304

Abstract

AIM:

Chronic right ventricle (RV) apical (RVA) pacing is standard treatment for an atrioventricular (AV) block but may be deleterious to left ventricle (LV) systolic function. Previous clinical studies of non-apical pacing have produced conflicting results. The aim of this randomized, prospective, international, multicentre trial was to compare change in LV ejection fraction (LVEF) between right ventricular apical and high septal (RVHS) pacing over a 2-year study period.

METHODS AND RESULTS:

We randomized 240 patients (age 74 11 years, 67% male) with a high-grade AV block requiring >90% ventricular pacing and preserved baseline LVEF >50%, to receive pacing at the RVA (n = 120) or RVHS (n = 120). At 2 years, LVEF decreased in both the RVA (57 9 to 55 9%, P = 0.047) and the RVHS groups (56 10 to 54 10%, P = 0.0003). However, there was no significant difference in intra-patient change in LVEF between confirmed RVA (n = 85) and RVHS (n = 83) lead position (P = 0.43). There were no significant differences in heart failure hospitalization, mortality, the burden of atrial fibrillation, or plasma brain natriutetic peptide levels between the two groups. A significantly greater time was required to place the lead in the RVHS position (70 25 vs. 56 24 min, P < 0.0001) with longer fluoroscopy times (11 7 vs. 5 4 min, P < 0.0001).

CONCLUSION:

In patients with a high-grade AV block and preserved LV function requiring a high percentage of ventricular pacing, RVHS pacing does not provide a protective effect on left ventricular function over RVA pacing in the first 2 years.

Item Details

Item Type:Refereed Article
Keywords:Left ventricular function; Right ventricular apical pacing; Right ventricular high septal pacing; Select site pacing
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Marwick, TH (Professor Tom Marwick)
ID Code:94497
Year Published:2015 (online first 2014)
Web of Science® Times Cited:23
Deposited By:Menzies Institute for Medical Research
Deposited On:2014-09-10
Last Modified:2017-11-01
Downloads:0

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