title: Exercise capacity and N-terminal pro-brain natriuretic peptide levels with biventricular vs. right ventricular pacing for atrioventricular block: results from the PREVENT-HF German Substudy.
abstract: OBJECTIVE
  Previous studies showed unfavourable effects of right ventricular (RV) pacing. Ventricular pacing (VP), however, is required in many patients with atrioventricular (AV) block. The PREVENT-HF study explored left ventricular (LV) remodelling during RV vs. biventricular (BIV) pacing in AV block without advanced heart failure. The pre-specified PREVENT-HF German Substudy examined exercise capacity and N-terminal pro-brain natriuretic peptide (NT-proBNP).
  
  
  RESULTS
  Patients with expected VP ≥80% were randomized to RV or BIV pacing. Endpoints were peak oxygen uptake (pVO2), oxygen uptake at the anaerobic threshold (VO2AT), ventilatory efficiency (VE/VCO2), and logNT-proBNP. Considering crossover, intention to treat (ITT), and on-treatment (OT) analyses of covariance (ANCOVA) were performed. For exercise testing 44 (RV: 25, BIV: 19), and for NT-proBNP 53 patients (RV: 29, BIV: 24) were included. The ITT analysis revealed significant differences in pVO2 [ANCOVA effect 2.83 mL/kg/min, confidence interval (CI) 0.83-4.91, P = 0.007], VO2AT (ANCOVA effect 2.14 mL/min/k, CI 0.14-4.15, P = 0.03), and VE/VCO2 (ANCOVA effect -5.46, CI -10.79 to -0.13, P = 0.04) favouring BIV randomization. The significant advantage in pVO2 persisted in OT analysis, while VO2AT and VE/VCO2 showed trends favouring BIV pacing. LogNT-proBNP did not differ between groups. (ITT: ANCOVA effect 0.008, CI -0.40 to +0.41, P = 0.97; OT: ANCOVA effect -0.03, CI -0.44 to 0.30, P = 0.90).
  
  
  CONCLUSIONS
  Our study suggests that BIV pacing produces better exercise capacity over 1 year compared with RV pacing in patients without advanced heart failure and AV block. In contrast, we observed no significant changes of NT-proBNP. Larger trials will allow appraising the clinical usefulness of BIV pacing in AV block. ClinicalTrials.gov Identifier: NCT00170326.
authors.affiliation: Charité - Universitaetsmedizin Berlin, Experimental and Clinical Research Center (ECRC), Lindenberger Weg 80, 13125 Berlin, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Stockburger
authors.forename: Eduardo
authors.initials: E
authors.lastname: de Teresa
authors.forename: Gervasio
authors.initials: G
authors.lastname: Lamas
authors.forename: Martin
authors.initials: M
authors.lastname: Desaga
authors.forename: Carsten
authors.initials: C
authors.lastname: Koenig
authors.forename: Dirk
authors.initials: D
authors.lastname: Habedank
authors.forename: Erik
authors.initials: E
authors.lastname: Cobo
authors.forename: Xavier
authors.initials: X
authors.lastname: Navarro
authors.forename: Uwe
authors.initials: U
authors.lastname: Wiegand
mesh_terms: D000368:Aged; D054537:Atrioventricular Block / Q000097:blood / Q000175:diagnosis* / Q000517:prevention & control*; D015415:Biomarkers / Q000097:blood; D058409:Cardiac Resynchronization Therapy Devices / Q000145:classification* / Q000706:statistics & numerical data*; D005080:Exercise Test / Q000706:statistics & numerical data*; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D020127:Recovery of Function; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Atrioventricular block; Biventricular pacing; Cardiac resynchronization therapy; Exercise testing; Heart failure; N-terminal pro-brain natriuretic peptide (NT-proBNP); Right ventricular pacing