Comparative assessment of right, left, and biventricular pacing in patients with permanent atrial fibrillation

Brignole, Michele; Gammage, Michael D.; Puggioni, Enrico; Alboni, Paoló; Raviele, Antonio; Sutton, Richard; Vardas, Panos; Bongiorni, Maria Grazia; Bergfeldt, Lennart; Menozzi, Carlo; Musso, Giacomo

doi:10.1093/eurheartj/ehi069

Cited by 175 publications

(73 citation statements)

References 25 publications

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“…Furthermore, the deleterious effect of RV pacing was mitigated by the use of biventricular pacing. Around the same time, Brignole et al randomized 56 patients with permanent AF who were undergoing AVJA and implantation of a biventricular pacing system to undergo either RV‐ or LV‐only pacing 6. Three months later, the patients were crossed over to the other arm.…”

Section: Discussionmentioning

confidence: 99%

“…Although right ventricular (RV) pacing has been most commonly used, concerns have been raised about the deleterious impact of RV pacing on clinical outcomes; in some patients, clinical deterioration can occur within months of pacemaker implantation 3. Thus, several investigators have explored the role of biventricular pacing in this patient population 4, 5, 6, 7, 8. However, these studies have produced conflicting results, likely in part because of the relatively few patients enrolled and variability in follow‐up duration.…”

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confidence: 99%

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Clinical Outcomes After Ablation of the AV Junction in Patients With Atrial Fibrillation: Impact of Cardiac Resynchronization Therapy

Mittal

Musat

Hoskins

et al. 2017

JAHA

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BackgroundPatients with atrial fibrillation (AF) often undergo AV junction ablation (AVJA) and pacemaker implantation. Right ventricular (RV) pacing contributes to increased risk of heart failure (HF), which may be mitigated by biventricular pacing. We sought to determine the impact of AVJA concurrent with RV versus biventricular pacemaker implantation on AF and HF hospitalizations.Methods and ResultsThe MarketScan Commercial and Medicare Supplemental claims database was used to select 18‐ to 100‐year‐old patients with AF with pacemaker implantation. Patients were divided into those with an RV and a biventricular pacemaker and further into those who did (AVJA +) or did not undergo concurrent ablation. Separately, the AVJA+ group was divided into those receiving RV versus biventricular pacemakers. AF and HF hospitalization rates were compared between groups after matching on demographics, comorbidities, and baseline hospitalization rates. The study included 24 361 patients, with RV (n=23 377) or biventricular (n=984) pacemakers; 1611 patients underwent AVJA. AVJA + was associated with reduced AF hospitalization risk (RV hazard ratio [HR], 0.31; P<0.001; biventricular HR, 0.20; P=0.003) compared with no AVJA. However, HF hospitalization risk was increased for RV (HR, 1.63; P=0.001), but not biventricular (HR, 0.98; P=0.942), pacemakers. In AVJA + patients, biventricular pacing was associated with reduced risk of HF hospitalization versus RV pacing (HR, 0.62; P=0.017).ConclusionsIn a large cohort of patients with AF, AVJA + significantly reduced AF hospitalizations, irrespective of whether an RV or a biventricular pacemaker was implanted. However, AVJA was associated with a marked HF hospitalization increase in patients with an RV pacemaker, which was ameliorated with biventricular pacing.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Clinical Outcomes After Ablation of the AV Junction in Patients With Atrial Fibrillation: Impact of Cardiac Resynchronization Therapy

Mittal

Musat

Hoskins

et al. 2017

JAHA

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“…Nevertheless, results of other studies concerning quality of life are very variable and do not always follow the above assumption. Some studies reported only slight improvement in quality of life in both groups observed, but with no signifi cant difference between them (27). It is also noteworthy that the observation periods in the pilot phase of our study were short (6+6 months).…”

Section: Discussionmentioning

confidence: 47%

TUGENDHAT: a pilot randomized study on effects of biventricular pacing in patients with bradycardia pacing indication and normal systolic function on heart failure, atrial fibrillation and quality of life (results of 12 month follow-up)

Táborský

Ríhová²,

Mráz³

et al. 2013

BLL

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Abstract:Background: Since the late 1990s, a growing number of clinical studies have indicated that long-term permanent right ventricular (RV) apical pacing will induce severe complications such as development of heart failure, increased burden of atrial fi brillation leading to decreased quality of life. Aim of the study: To investigate whether cardiac resynchronization therapy (CRT) using biventricular (BiV) pacing can prevent the development of left ventricular (LV) dysfunction, LV remodelling, worsening of the clinical status and quality of life in chronically RV paced patients with normal LV ejection fraction (EF). Methods and results:A total of 127 patients with Class I indication for permanent cardiac pacing and without established indication for CRT were subjected to 6 months of RV and BiV pacing in a patient-blinded, randomized crossover trial. Treatment effects of BiV pacing were evaluated for LV function, LV remodelling and clinical status. Conclusion: BiV pacing, compared to RV pacing, did not change LV function and quality of life in patients with the absence of LV dysfunction or remodelling, standard bradycardia pacing indications in a pilot phase (12-month follow-up) of the TUGENDHAT trial. The fi nal report will be published after 60-month follow-up termination (Tab. 5, Fig. 3, Ref. 30). Full Text in PDF www.elis.sk. Key words: BiV and RV pacing, LV remodelling, heart failure, atrial fi brillation, quality of life. Results of several trials have supported the fact that right ventricular (RV) apical pacing might lead to adverse clinical outcomes in patients with standard pacing indications. Nevertheless, RV apical pacing continues to be practiced by many physicians because of its easy accessibility and relative stability over time (1, 2). The optimal mode and site of pacing remain undefi ned.The detrimental effect of RV pacing is probably most important in patients with pre-existing left ventricular (LV) dysfunction and may lead to worsening of heart failure (3, 4). In RV pacing, the sequence of electrical activation resembles the activation pattern in left bundle branch block (LBBB). This asynchronous electrical pattern is accompanied by abnormal dyssynchronous mechanical interactions within the LV (5). Experimental data suggested that biventricular (BiV) pacing might preserve myocardial performance better than RV apical pacing in patients with atrioventricular (AV) block and normal systolic function (6). The underlying mechanism may be a signifi cant reduction in LV systolic dyssynchrony, as shown by Cojoc et al (7). In the majority of patients with severe LV dysfunction and severe clinical heart failure associated with either LBBB-or RV pacing-induced dyssynchrony, BiV pacing improves clinical status, reduces mortality and morbidity, reduces heart failure (HF) hospitalizations, reverses LV remodelling and improves LV function (8, 9). Therefore, BiV pacing is nowadays recommended in patients with ventricular dyssynchrony (QRS > 120 ms), severe LV dysfunction [LV ejection fraction (LVEF) < 0.35] ...

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“…Few randomized trials have been done in order to assess the efficacy of CRT in AF patients [58][59][60]. The MUSTIC trial showed good one-year results of biventricular pacing in patients with severe HF and major intraventricular conduction disturbances with either SR or AF [58].…”

Section: Heart Failure: Cardiac Resynchronization Therapy In Afmentioning

confidence: 99%

“…Furthermore, the global effective 'CRT-dose' may be markedly reduced compared with atrial synchronous rhythm with a short AV interval achieved during SR, since the number of effective biventricular captured beats are reduced. Moreover, in AF patients, spontaneous ventricular rate tends to overdrive biventricular pacing rates during exertion, determining a further reduction of paced beats precisely when patients are most in need of biventricular capture, and thus greatly limiting functional capacity [60,61]. Another problem is the possible negative impact on prognosis of negative chronotropic therapy in achieving adequate rate control.…”

Section: Heart Failure: Cardiac Resynchronization Therapy In Afmentioning

confidence: 99%

Implanted Devices and Atrial Fibrillation

Guerra¹,

Brambatti²,

Matassini³

et al. 2012

Current Issues and Recent Advances in Pacemaker Therapy

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Comparative assessment of right, left, and biventricular pacing in patients with permanent atrial fibrillation

Abstract: Rhythm regularization achieved with AV-junction ablation improved quality of life and exercise capacity with all modes of pacing. LV and BiV pacing provided modest or no additional favourable effect compared with RV pacing.

Cited by 175 publications

References 25 publications

Clinical Outcomes After Ablation of the AV Junction in Patients With Atrial Fibrillation: Impact of Cardiac Resynchronization Therapy

Clinical Outcomes After Ablation of the AV Junction in Patients With Atrial Fibrillation: Impact of Cardiac Resynchronization Therapy

TUGENDHAT: a pilot randomized study on effects of biventricular pacing in patients with bradycardia pacing indication and normal systolic function on heart failure, atrial fibrillation and quality of life (results of 12 month follow-up)

Implanted Devices and Atrial Fibrillation

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