title: Atrial support pacing in heart failure: results from the multicenter PEGASUS CRT trial.
abstract: BACKGROUND
  Cardiac resynchronization therapy (CRT) efficacy trials to date used atrial-synchronous biventricular pacing wherein there is no or minimal atrial pacing. However, bradycardia and chronotropic incompetence are common in this patient population. This trial was designed to evaluate the effect of atrial support pacing among heart failure patients receiving a CRT defibrillator.
  
  
  RESULTS
  PEGASUS CRT was a multicenter, 3-arm, randomized study. At 6 weeks, patients were randomized to DDD mode at a lower rate of 40 bpm (DDD-40; control arm), or one of the following 2 treatment arms: DDD-70, or DDDR-40. The primary endpoint was a clinical composite endpoint that included all-cause mortality, heart failure events, NYHA functional class, and patient global self-assessment. Subjects were classified as improved, unchanged, or worsened at 12 months. There were 1,433 patients randomized, of whom 66% were male, mean age was 67 ± 11 years, and mean left ventricular ejection fraction was 23 ± 7%. The average follow-up time was 10.5 ± 3.5 months and 1,309 patients contributed to the primary endpoint. No significant differences were observed in the composite endpoint between either of the 2 treatment arms compared to the control arm (P>0.05 for both comparisons). Additionally, there were no differences among the groups in mortality or heart failure events.
  
  
  CONCLUSIONS
  In advanced heart failure patients treated with CRT, atrial support pacing did not improve clinical outcomes compared to atrial tracking. However, atrial pacing did not adversely affect mortality or heart failure events.
authors: Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors: David O
authors: DO
authors: Martin
authors: John D
authors: JD
authors: Day
authors: Peter Y
authors: PY
authors: Lai
authors: Allan L
authors: AL
authors: Murphy
authors: Hemal M
authors: HM
authors: Nayak
authors: Rollo P
authors: RP
authors: Villareal
authors: Stanislav
authors: S
authors: Weiner
authors: Stacia M
authors: SM
authors: Kraus
authors: Kira Q
authors: KQ
authors: Stolen
authors: Michael R
authors: MR
authors: Gold
mesh_terms: D000368:Aged; D001315:Australia / Q000453:epidemiology; D002304:Cardiac Pacing, Artificial / Q000401:mortality*; D058406:Cardiac Resynchronization Therapy / Q000401:mortality*; D015897:Comorbidity; D005260:Female; D006325:Heart Atria; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008297:Male; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control*