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.
OBJECTIVE
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.


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).


CONCLUSIONS
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.
Albertsen
Andi E
AE
Department of Cardiology, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, DK-8200 Aarhus N, Denmark. andieie@gmail.com
Nielsen
Jens C
JC
Poulsen
Steen H
SH
Mortensen
Peter T
PT
Pedersen
Anders K
AK
Hansen
Peter S
PS
Jensen
Henrik K
HK
Egeblad
Henrik
H
D000368:Aged; D000369:Aged, 80 and over; D054537:Atrioventricular Block / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D019560:Echocardiography, Three-Dimensional; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010138:Pacemaker, Artificial; D010446:Peptide Fragments / Q000097:blood; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*
D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain