Effect of right ventricular pacing lead site on left ventricular function in patients with high-grade atrioventricular block: results of the Protect-Pace study

被引:154
作者
Kaye, Gerald C. [1 ,2 ]
Linker, Nicholas J. [3 ]
Marwick, Thomas H. [4 ]
Pollock, Lucy [5 ]
Graham, Laura [5 ]
Pouliot, Erika [6 ]
Poloniecki, Jan [7 ]
Gammage, Michael [8 ]
机构
[1] Univ Queensland, Dept Cardiol, Brisbane, Qld 4102, Australia
[2] Princess Alexandra Hosp, Brisbane, Qld 4102, Australia
[3] James Cook Univ Hosp, Middlesbrough, Cleveland, England
[4] Menzies Res Inst Tasmania, Hobart, Tas, Australia
[5] Medtron Ltd, Watford, Herts, England
[6] Medtron, Minneapolis, MN USA
[7] St Georges Med Sch, London, England
[8] Univ Birmingham, Sch Med, Birmingham, W Midlands, England
关键词
Right ventricular apical pacing; Right ventricular high septal pacing; Left ventricular function; Select site pacing; IMMATURE CANINE HEART; OUTFLOW TRACT; FAILURE; STIMULATION; DYSFUNCTION; ACTIVATION; PACEMAKER; CHAMBER; SOCIETY; SEPTUM;
D O I
10.1093/eurheartj/ehu304
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aim Chronic right ventricle (RV) apical (RVA) pacing is standard treatment for an atrioventricular (AV) block but may be deleterious to left ventricle (LV) systolic function. Previous clinical studies of non-apical pacing have produced conflicting results. The aim of this randomized, prospective, international, multicentre trial was to compare change in LV ejection fraction (LVEF) between right ventricular apical and high septal (RVHS) pacing over a 2-year study period. Methods and results We randomized 240 patients (age 74 +/- 11 years, 67% male) with a high-grade AV block requiring > 90% ventricular pacing and preserved baseline LVEF > 50%, to receive pacing at the RVA (n = 120) or RVHS (n = 120). At 2 years, LVEF decreased in both the RVA (57 +/- 9 to 55 +/- 9%, P = 0.047) and the RVHS groups (56 +/- 10 to 54 +/- 10%, P = 0.0003). However, there was no significant difference in intra-patient change in LVEF between confirmed RVA (n = 85) and RVHS (n = 83) lead position (P = 0.43). There were no significant differences in heart failure hospitalization, mortality, the burden of atrial fibrillation, or plasma brain natriutetic peptide levels between the two groups. A significantly greater time was required to place the lead in the RVHS position (70 +/- 25 vs. 56 +/- 24 min, P < 0.0001) with longer fluoroscopy times (11 +/- 7 vs. 5 +/- 4 min, P < 0.0001). Conclusion In patients with a high-grade AV block and preserved LV function requiring a high percentage of ventricular pacing, RVHS pacing does not provide a protective effect on left ventricular function over RVA pacing in the first 2 years.
引用
收藏
页码:856 / 862
页数:7
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