Reduction of unnecessary right ventricular pacing by managed ventricular pacing and search AV+ algorithms in pacemaker patients: 12-month follow-up results of a randomized study.
OBJECTIVE
The present study was to assess the reduction of right ventricular pacing (RVP) by pacemaker algorithms of Managed Ventricular Pacing (MVP) and Search AV+ (SAV+) interval over a period of 12 months.


RESULTS
A total of 385 patients indicated for a dual-chamber pacemaker (DC-PM) were enrolled in the prospective, randomized COMPARE study at 29 centres in China between June 2009 and April 2011. Patients implanted with DC-PMs were randomized in a 1 : 1 ratio to the MVP group or the SAV+ group. The percentage of VP (%VP) was obtained from the device diagnostic data at 1-, 6-, and 12-month follow-ups and was expressed as the median %VP over all beats in patients with sinus node dysfunction (SND) and atrioventricular block (AVB) excluding persistent third-degree AVB. Of 385 enrolled patients, 253 had SND and 72 had AVB. The %VP in the MVP group was significantly lower than that in the SAV+ group at 1-, 6-, and 12-month follow-ups, respectively. At 12-month follow-up, the median %VP in SND patients was 0.20% in the MVP group and 1.4% in the SAV+ group (P < 0.0001) and the median %VP in AVB patients was 11.8% in the MVP group and 98.1% in the SAV+ group (P < 0.001). There was no statistical difference in %VP from 1- to 12-month follow-up. A trend in the correlation between %VP and AT/AF burden was observed.


CONCLUSIONS
Over 12-month follow-up, the %VP was lower for MVP than SAV+ in patients with either SND or AVB. The sustainable %VP reduction has potential implications in reducing the development of heart failure and/or atrial arrhythmia morbidity.
Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangzhou, China.
Silin
S
Chen
Clinical EP Lab and Arrhythmic Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishilu, Beijing 100037, China.
Keping
K
Chen
Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, China.
Qianmin
Q
Tao
Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, China.
Liangrong
L
Zheng
Department of Cardiology, Zhejiang Hospital, Zhejiang, China.
Farong
F
Shen
Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangzhou, China.
Shulin
S
Wu
Department of Cardiology, First Peoples' Hospital of Yunnan Province, Yunnan, China.
Jie
J
Fan
Department of Cardiovascular, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, China.
Geng
G
Xu
Medtronic (Shanghai) Management Co., Ltd., Shanghai, China.
Li
L
Wang
Medtronic, Inc., MN, USA.
Xiaohong
X
Zhou
Clinical EP Lab and Arrhythmic Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishilu, Beijing 100037, China zsfuwai@vip.163.com.
Shu
S
Zhang
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001281:Atrial Fibrillation / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D054537:Atrioventricular Block / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000379:methods*; D002681:China; D004867:Equipment Design; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011446:Prospective Studies; D012804:Sick Sinus Syndrome / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D012815:Signal Processing, Computer-Assisted; D013997:Time Factors; D016896:Treatment Outcome; D018754:Ventricular Dysfunction / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D016278:Ventricular Function, Right
Atrioventricular block; Dual-chamber pacemaker; Managed ventricular pacing; Right ventricular pacing; Sinus node dysfunction