title: Minimizing right ventricular pacing in pacemaker patients with intact and compromised atrioventricular conduction : Results from the EVITA Trial.
abstract: BACKGROUND
  Unnecessary ventricular pacing is associated with increased morbidity and mortality. Over the years different algorithms have been developed to reduce right ventricular pacing.
  
  
  OBJECTIVE
  Goal of the present study was to test the efficacy of the ventricular intrinsic preference (VIP) algorithm in patients with atrioventricular intact (AVi) and atrioventricular compromised (AVc) AV-conduction.
  
  
  METHODS
  Evaluation of VIP feature in pacemaker patients (EVITA) was a multicenter, prospective, randomized trial (Trials.gov Identifier: NCT00366158). In total, 389 patients were randomized to AVc group: n = 140/132 VIP OFF/VIP On, AVi group: n = 54/63 VIP OFF/VIP ON). One-month post-implantation AV conduction testing (AVc: PR/AR interval > 210 ms) was performed. Follow-up visits occurred 6 and 12 months after DDD-pacemaker implantation.
  
  
  RESULTS
  In AVi and AVc-patients initiation of the VIP feature significantly reduced incidence of ventricular pacing (AVi: 53 ± 38 vs. 9 ± 21%, p = 0.0001; AVc: 79 ± 31 vs. 28 ± 35%, p = 0.0001). DDD-pacemaker implantation per se significantly reduced incidence of AF in VIP ON (AVi 27 vs. 0%, p < 0.0001; AVc 29 vs. 3%, p < 0.0001) and VIP OFF patients (AVi 43 vs. 4%, p < 0.0001; AVc 33 vs. 3, p < 0.0001), without significant differences between VIP ON and OFF groups (p > 0.05). In the AVc group activation of VIP significantly reduced incidence of adverse events (AE). All-cause mortality was not significantly different in VIP ON (n = 5) and VIP OFF (n = 4, p > 0.05) patients.
  
  
  CONCLUSIONS
  AV search hysteresis (VIP) markedly reduces ventricular pacing both in patients with normal AV conduction and in patients with prolonged PR interval or intermittent AV block.
authors: Department of Cardiology, Diakonieklinikum Schwäbisch Hall/Klinikum Crailsheim, Diakoniestrasse 12, 74523, Schwäbisch Hall, Germany. alexander.bauer@dasdiak.de.
authors: A
authors: A
authors: Bauer
authors: AZ Sint Dimpna, Geel, Belgium.
authors: J
authors: J
authors: Vermeulen
authors: Helsinki University Central Hospital, Helsinki, Finland.
authors: L
authors: L
authors: Toivonen
authors: Mustamae Hospital, Tallin, Estonia.
authors: J
authors: J
authors: Voitk
authors: Russels-Hall Hospital, Dudley, United Kingdom.
authors: C
authors: C
authors: Barr
authors: O.L. Vrouwziekenhuis Campus, Asse, Belgium.
authors: P
authors: P
authors: Peytchev
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D054537:Atrioventricular Block / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control; D001919:Bradycardia / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control*; D002304:Cardiac Pacing, Artificial / Q000379:methods* / Q000706:statistics & numerical data*; D015897:Comorbidity; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D016037:Single-Blind Method; D015996:Survival Rate; D013813:Therapy, Computer-Assisted / Q000379:methods* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult
keywords: Atrioventricular-hysteresis; Electrophysiology; Heart failure; Pacemaker