title: 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.
abstract: 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.
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, DK-8200 Aarhus N, Denmark. andieie@gmail.com
authors.forename: Andi E
authors.initials: AE
authors.lastname: Albertsen
authors.forename: Jens C
authors.initials: JC
authors.lastname: Nielsen
authors.forename: Steen H
authors.initials: SH
authors.lastname: Poulsen
authors.forename: Peter T
authors.initials: PT
authors.lastname: Mortensen
authors.forename: Anders K
authors.initials: AK
authors.lastname: Pedersen
authors.forename: Peter S
authors.initials: PS
authors.lastname: Hansen
authors.forename: Henrik K
authors.initials: HK
authors.lastname: Jensen
authors.forename: Henrik
authors.initials: H
authors.lastname: Egeblad
mesh_terms: 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*
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain