scholarly journals Chronic Apical and Nonapical Right Ventricular Pacing in Patients with High-Grade Atrioventricular Block: Results of the Right Pace Study

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Carmine Muto ◽  
Valeria Calvi ◽  
Giovanni Luca Botto ◽  
Domenico Pecora ◽  
Daniele Porcelli ◽  
...  
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Secondary Outcome ◽  
X Rays ◽  
Ventricular Pacing ◽  
Dual Chamber ◽  
Dual Chamber Pacemaker ◽  
Right Ventricular Pacing ◽  
The Right

Objective. The aim of the study was to compare the two approaches to chronic right ventricular pacing currently adopted in clinical practice: right ventricular apical (RVA) and non-RVA pacing. Background. Chronic RVA pacing is associated with an increased risk of atrial fibrillation, morbidity, and even mortality. Non-RVA pacing may yield more physiologic ventricular activation and provide potential long-term benefits and has recently been adopted as standard procedure at many implanting centers. Methods. The Right Pace study was a multicenter, prospective, single-blind, nonrandomized trial involving 437 patients indicated for dual-chamber pacemaker implantation with a high percentage of RV pacing. Results. RV lead-tip target location was the apex or the interventricular septum. RVA (274) and non-RVA patients (163) did not differ in baseline characteristics. During a median follow-up of 19 months (25th–75th percentiles, 13–25), 17 patients died. The rates of the primary outcome of death due to any cause or hospitalization for heart failure were comparable between the groups (log-rank test, p=0.609), as were the rates of the composite of death due to any cause, hospitalization for heart failure, or an increase in left ventricular end-systolic volume ≥ 15% as compared with the baseline evaluation (secondary outcome, p=0.703). After central adjudication of X-rays, comparison between adjudicated RVA (239 patients) and non-RVA (170 patients) confirmed the absence of difference in the rates of primary (p=0.402) and secondary (p=0.941) outcome. Conclusions. In patients with indications for dual-chamber pacemaker who require a high percentage of ventricular stimulation, RVA or non-RVA pacing resulted in comparable outcomes. This study is registered with ClinicalTrials.gov (identifier: NCT01647490).

scholarly journals Relationship between right ventricular pacing and non-sustained ventricular arrhythmias in patients with dual-chamber pacemaker and normal range left ventricular ejection fraction

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Rayan S. El-Zein ◽  
Anish K. Amin ◽  
Sreedhar R. Billakanty ◽  
Eugene Y. Fu ◽  
Allan J. Nichols ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Ventricular Arrhythmias ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Pacing ◽  
Normal Range ◽  
Dual Chamber ◽  
Dual Chamber Pacemaker ◽  
Right Ventricular Pacing ◽  
The Impact

Abstract Background Right ventricular pacing (RVP) increases heart failure, AF, and death rates in pacemaker patients and ventricular arrhythmias (VAs) in defibrillator patients. However, the impact of RVP on VAs burden and its clinical significance in pacemaker patients with normal range LVEF of > 50–55% remains unknown. We sought to evaluate the relationship of RVP and VAs and its clinical impact in a pacemaker patient population. Methods Records of 105 patients who underwent denovo dual-chamber pacemaker implant or a generator change (Medtronic™ or Boston Scientific™) for AV block and sinus node disease at a tertiary care center between September 1, 2015, and September 1, 2016, were retrospectively reviewed. Results Data from 105 patients (51% females, mean age 76 ± 1 years, mean LVEF 61 ± 0.7%) without history of VAs (98.2%) were reviewed over 1044 ± 23 days. Dependent patients (100% RVP) exhibited the lowest VAs burden when compared to < 100% RVP (isolated PVCs, PVC runs of < 4 beats, and NSVT; p ≤ 0.001). Patients with < 1% RVP also exhibited low VA burden with intermediate RVP (1–99.9%) being most arrhythmogenic for PVC runs (p = 0.04) and for isolated PVCs (p = 0.006). Antiarrhythmics/beta and calcium channel blockers use and stress tests performed to evaluate VAs which were positive requiring intervention did not differ significantly. Burden of > 1/h of PVC runs and increasing PVC runs/h were significantly associated with hospitalization (p = 0.04) and all-cause mortality (p = 0.03), respectively. Conclusions In pacemaker patients with normal range LVEF (> 50–55%), 100% RVP is associated with the lowest burden of NSVT. Furthermore, patients with < 1% RVP also exhibit low VA burden; however, intermittent RVP seems to significantly correlate with non-sustained VAs.

676 Right ventricular pacing does not affect the occurrence of atrial tachyarrhythmias in dual chamber pacemaker patients

EP Europace ◽  
2005 ◽  
Vol 7 (Supplement_1) ◽  
pp. 164-164
Author(s):  
B. Huegl ◽  
A. Große ◽  
E. Al Kandari ◽  
A. Al Sayegh ◽  
T. Karow ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Ventricular Pacing ◽  
Dual Chamber ◽  
Dual Chamber Pacemaker ◽  
Right Ventricular Pacing ◽  
Atrial Tachyarrhythmias

43Dynamic atrioventricular delay achieves superior electrical synchrony when pacing both ventricles rather than left ventricle alone

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
B Thibault ◽  
A Chow ◽  
J Mangual ◽  
N Badie ◽  
P Waddingham ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Ventricular Pacing ◽  
Right Ventricular Pacing ◽  
Atrioventricular Delay ◽  
Intrinsic Conduction ◽  
Left Ventricular Pacing ◽  
Additional Reference ◽  
The Right

Abstract Funding Acknowledgements Abbott Introduction Automatic adjustment of atrioventricular delay (AVD) with SyncAV has been shown to improve electrical synchronization when pacing one or two sites in the left ventricle together with the right ventricle. However, it is unknown if the same benefit can be gained by using SyncAV while pacing only the left ventricle without right ventricular pacing. Purpose   Evaluate the acute improvement in electrical synchrony provided by SyncAV with and without MultiPoint Pacing (MPP) during biventricular (BiV) and LV only pacing. Methods   Patients with LBBB and QRS duration (QRSd) ≥ 150 ms scheduled for CRT-P/D device implantation with quadripolar LV lead were enrolled in this prospective study. QRSd was measured post-implant from 12-lead surface electrograms by blinded experts during the following pacing configurations: intrinsic conduction, conventional BiV (BiV = RV + LV1), MPP (MPP = RV + LV1 + LV2), LV-only single-site (LVSS = LV1 only), and LV-only MPP (LVMPP = LV1 + LV2). For each pacing mode, SyncAV was enabled (e.g. BiV + SyncAV) with the patient-tailored SyncAV offset that minimized QRSd. As an additional reference, QRSd during BiV was also measured using the nominal static AVD (paced/sensed AVD = 140/110 ms). BiV and LVSS pacing used the latest activating LV cathode, whereas MPP and LVMPP used the two LV cathodes with the widest possible separation (&gt;30mm). All configurations used the minimum programmable RV-LV and LV1-LV2 delays. Results   Thirty-five patients (78% male, 33% ischemic, 26% ejection fraction, 165 ms intrinsic QRSd) completed device implant and QRSd assessment. Relative to intrinsic conduction, BiV with nominal AVD reduced the QRSd by 17.5% (p &lt; 0.001 vs intrinsic). Enabling SyncAV with a patient-optimized offset significantly improved QRSd reduction. BiV + SyncAV reduced QRSd by 25.2% (p &lt; 0.001 vs. BiV). The greatest QRSd reduction of 28.9% was achieved by MPP + SyncAV (p &lt; 0.01 vs. BiV + SyncAV). Single- and multi-site LV-only pacing reduced QRSd significantly less than corresponding biventricular modes. LVSS + SyncAV reduced QRSd by 22.5% (p &lt; 0.05 vs. BiV + SyncAV), and LVMPP + SyncAV reduced QRSd by 24.3% (p &lt; 0.05 vs. MPP + SyncAV). As a percent of PR interval, optimal SyncAV offsets were similar for BiV + SyncAV (median: 13%, mean: 17%) vs. MPP + SyncAV (median: 13%, mean 16%, p = 0.35 vs. BiV + SyncAV), and similar for LVSS + SyncAV (median: 20%, mean: 28%) and LVMPP + SyncAV (median: 23%, mean: 26%, p = 0.35 vs. LVSS + SyncAV), but were significantly higher for LV-only settings vs. corresponding BiV/MPP settings (p &lt; 0.01 for both pairs). Conclusion: Greater improvement in electrical synchrony using SyncAV was observed when right ventricular pacing was included with left ventricular pacing. Additional benefit was gained by the addition of a second left ventricular pacing site with MPP in combination with SyncAV in both biventricular and LV only pacing modes. Abstract Figure.

scholarly journals New Onset Heart Failure after Right Ventricular Pacing in Patients with Normal Left Ventricular Function

2021 ◽  
Vol 10 (1) ◽  
pp. 365-369
Author(s):  
Fawad Qadir ◽  
Muhammad Shahid ◽  
Hadi Yousuf Saeed ◽  
Muhammad Tahir Mohyudin ◽  
Abu Bakar Ali Saad ◽  
...  
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Lv Function ◽  
Av Block ◽  
Ventricular Pacing ◽  
Right Ventricular Pacing ◽  
Normal Left Ventricular ◽  
New Onset

Background: Cardiac pacing is the best optional treatment for cardiac rhythm disturbances such as cardiac arrhythmias, high grade atrioventricular (AV) block and heart failure (HF). Right ventricular apical (RVA) pacing in patients with normal left ventricular heart, may stimulate HF and cardiomyopathy. The objective of this study was to determine the frequency of new-onset heart failure after right ventricular apical pacing in patients having normal left ventricular (LV) function. Material and Methods: This prospective study was conducted from March 2017 to January 2019 in Chaudhry Pervaiz Elahi (CPE) Institute of Cardiology, Multan Pakistan. Adult patients (n=50) who fulfilled the American College of Cardiology (ACC) guidelines for permanent pacemaker (PPM) insertion and with normal LV function were included in this study. Pacemaker was implanted in all patients under local anesthesia. All patients were followed up for six months to determine the occurrence of heart failure. 2-D echocardiography was done to determine heart failure at follow up in pacemaker clinic. Results: Mean age of the study participants was 50.53 ± 6.75 years with male predominance. Mean pre-implantation ejection fraction (EF%) was 55.4 ± 4.2%. Main reason of PPM insertion was third degree AV block followed by right bundle branch block (RBBB). Incidence of HF was 4% at 06 months’ follow-up. Mortality occurred only in 1 (2%) patient. Conclusions: Right ventricular pacing is associated with risk of new onset heart failure in long term follow-up. In the present study, HF developed in 4% patients in a follow-up period of six months

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