Top

Published in:

01-11-2018

Cardiac resynchronization therapy improves left ventricular remodeling and function compared with right ventricular pacing in patients with atrioventricular block

Authors: Dasheng Lu, Hao Zhang, Hongxiang Zhang

Published in: Heart Failure Reviews | Issue 6/2018

Abstract

Right ventricular pacing (RVP) exerts a detrimental effect on left ventricular (LV) remodeling. In patients with atrioventricular block (AVB) that require ventricular pacing, the effect of biventricular pacing (BiVP) versus RVP on LV remodeling and function has not been comprehensively assessed in a meta-analysis. Electric databases MEDLINE and Cochrane Library were retrieved for randomized controlled trials (RCT) comparing RVP and BiVP in patients with AVB. Data on left ventricular ejection fraction (LVEF) and LV volumes were analyzed, stratified by different time points. Eleven RCTs were included in the final analysis. There was a significant reduction of LV end-systolic volume in BiVP compared with RVP, at 3, 6, 12, and 24 months follow-up (P < 0.05 for all). BiVP was associated with a decreased LV end-diastolic volume in comparison to RVP at 3, 6, and 12 months. Compared with RVP, BiVP had a higher LVEF at all follow-up visits, with mean difference of 5.91, 3.29, 3.9, 6.66, and 8.69% at 3, 6, 12, 24, and beyond 24 months follow-up, respectively. The results were not significantly changed in sensitivity analysis after removal of studies with mean baseline LVEF < 50% or excluding studies with ablation-induced AVB. In patients with AVB and bradycardia that require ventricular pacing, BiVP is superior to RVP in improving LV remodeling and function.

Available only for authorised users

Tse HF, Yu C, Wong KK, Tsang V, Leung YL, Ho WY, Lau CP (2002) Functional abnormalities in patients with permanent right ventricular pacing: the effect of sites of electrical stimulation. J Am Coll Cardiol 40(8):1451–1458CrossRefPubMed

Nielsen JC, Andersen HR, Thomsen PE, Thuesen L, Mortensen PT, Vesterlund T, Pedersen AK (1998) Heart failure and echocardiographic changes during long-term follow-up of patients with sick sinus syndrome randomized to single-chamber atrial or ventricular pacing. Circulation 97(10):987–995CrossRefPubMed

Zhang XH, Chen H, Siu CW, Yiu KH, Chan WS, Lee KL, Chan HW, Lee SW, Fu GS, Lau CP, Tse HF (2008) New-onset heart failure after permanent right ventricular apical pacing in patients with acquired high-grade atrioventricular block and normal left ventricular function. J Cardiovasc Electrophysiol 19(2):136–141. https://doi.org/10.1111/j.1540-8167.2007.01014.x CrossRefPubMed

Sweeney MO, Hellkamp AS, Ellenbogen KA, Greenspon AJ, Freedman RA, Lee KL, Lamas GA (2003) Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation 107(23):2932–2937. https://doi.org/10.1161/01.cir.0000072769.17295.b1 CrossRefPubMed

Sharma AD, Rizo-Patron C, Hallstrom AP, O'Neill GP, Rothbart S, Martins JB, Roelke M, Steinberg JS, Greene HL (2005) Percent right ventricular pacing predicts outcomes in the DAVID trial. Heart Rhythm 2(8):830–834. https://doi.org/10.1016/j.hrthm.2005.05.015 CrossRefPubMed

Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E, Kocovic DZ, Packer M, Clavell AL, Hayes DL, Ellestad M, Trupp RJ, Underwood J, Pickering F, Truex C, McAtee P, Messenger J (2002) Cardiac resynchronization in chronic heart failure. N Engl J Med 346(24):1845–1853. https://doi.org/10.1056/NEJMoa013168 CrossRefPubMed

Brignole M, Gammage M, Puggioni E, Alboni P, Raviele A, Sutton R, Vardas P, Bongiorni MG, Bergfeldt L, Menozzi C, Musso G (2005) Comparative assessment of right, left, and biventricular pacing in patients with permanent atrial fibrillation. Eur Heart J 26(7):712–722. https://doi.org/10.1093/eurheartj/ehi069 CrossRefPubMed

Stavrakis S, Garabelli P, Reynolds DW (2012) Cardiac resynchronization therapy after atrioventricular junction ablation for symptomatic atrial fibrillation: a meta-analysis. Europace 14(10):1490–1497. https://doi.org/10.1093/europace/eus193 CrossRefPubMed

Brignole M, Botto G, Mont L, Iacopino S, De Marchi G, Oddone D, Luzi M, Tolosana JM, Navazio A, Menozzi C (2011) Cardiac resynchronization therapy in patients undergoing atrioventricular junction ablation for permanent atrial fibrillation: a randomized trial. Eur Heart J 32(19):2420–2429. https://doi.org/10.1093/eurheartj/ehr162 CrossRefPubMed

10.

Kindermann M, Hennen B, Jung J, Geisel J, Bohm M, Frohlig G (2006) Biventricular versus conventional right ventricular stimulation for patients with standard pacing indication and left ventricular dysfunction: the Homburg Biventricular Pacing Evaluation (HOBIPACE). J Am Coll Cardiol 47(10):1927–1937. https://doi.org/10.1016/j.jacc.2005.12.056 CrossRefPubMed

11.

Yu CM, Chan JY, Zhang Q, Omar R, Yip GW, Hussin A, Fang F, Lam KH, Chan HC, Fung JW (2009) Biventricular pacing in patients with bradycardia and normal ejection fraction. N Engl J Med 361(22):2123–2134. https://doi.org/10.1056/NEJMoa0907555 CrossRefPubMed

12.

Curtis AB, Worley SJ, Adamson PB, Chung ES, Niazi I, Sherfesee L, Shinn T, Sutton MS (2013) Biventricular pacing for atrioventricular block and systolic dysfunction. N Engl J Med 368(17):1585–1593. https://doi.org/10.1056/NEJMoa1210356 CrossRefPubMed

13.

Stockburger M, Gomez-Doblas JJ, Lamas G, Alzueta J, Fernandez-Lozano I, Cobo E, Wiegand U, Concha JF, Navarro X, Navarro-Lopez F, de Teresa E (2011) Preventing ventricular dysfunction in pacemaker patients without advanced heart failure: results from a multicentre international randomized trial (PREVENT-HF). Eur J Heart Fail 13(6):633–641. https://doi.org/10.1093/eurjhf/hfr041 CrossRefPubMed

14.

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6(7):e1000100. https://doi.org/10.1371/journal.pmed.1000100 CrossRefPubMedPubMedCentral

15.

Doshi RN, Daoud EG, Fellows C, Turk K, Duran A, Hamdan MH, Pires LA (2005) Left ventricular-based cardiac stimulation post AV nodal ablation evaluation (the PAVE study). J Cardiovasc Electrophysiol 16(11):1160–1165. https://doi.org/10.1111/j.1540-8167.2005.50062.x CrossRefPubMed

16.

Albertsen AE, Nielsen JC, Poulsen SH, Mortensen PT, Pedersen AK, Hansen PS, Jensen HK, Egeblad H (2008) Biventricular pacing preserves left ventricular performance in patients with high-grade atrio-ventricular block: a randomized comparison with DDD(R) pacing in 50 consecutive patients. Europace 10(3):314–320. https://doi.org/10.1093/europace/eun023 CrossRefPubMed

17.

Martinelli Filho M, de Siqueira SF, Costa R, Greco OT, Moreira LF, D'Avila A, Heist EK (2010) Conventional versus biventricular pacing in heart failure and bradyarrhythmia: the COMBAT study. J Card Fail 16(4):293–300. https://doi.org/10.1016/j.cardfail.2009.12.008 CrossRefPubMed

18.

Orlov MV, Gardin JM, Slawsky M, Bess RL, Cohen G, Bailey W, Plumb V, Flathmann H, de Metz K (2010) Biventricular pacing improves cardiac function and prevents further left atrial remodeling in patients with symptomatic atrial fibrillation after atrioventricular node ablation. Am Heart J 159(2):264–270. https://doi.org/10.1016/j.ahj.2009.11.012 CrossRefPubMed

19.

Albertsen AE, Mortensen PT, Jensen HK, Poulsen SH, Egeblad H, Nielsen JC (2011) Adverse effect of right ventricular pacing prevented by biventricular pacing during long-term follow-up: a randomized comparison. Eur J Echocardiogr 12(10):767–772. https://doi.org/10.1093/ejechocard/jer136 CrossRefPubMed

20.

Chan JY, Fang F, Zhang Q, Fung JW, Razali O, Azlan H, Lam KH, Chan HC, Yu CM (2011) Biventricular pacing is superior to right ventricular pacing in bradycardia patients with preserved systolic function: 2-year results of the PACE trial. Eur Heart J 32(20):2533–2540. https://doi.org/10.1093/eurheartj/ehr336 CrossRefPubMed

21.

Yu CM, Fang F, Luo XX, Zhang Q, Azlan H, Razali O (2014) Long-term follow-up results of the pacing to avoid cardiac enlargement (PACE) trial. Eur J Heart Fail 16(9):1016–1025. https://doi.org/10.1002/ejhf.157 CrossRefPubMed

22.

John Sutton M, Plappert T, Adamson PB, Li P, Christman SA, Chung ES, Curtis AB (2015) Left ventricular reverse remodeling with biventricular versus right ventricular pacing in patients with atrioventricular block and heart failure in the BLOCK HF Trial. Circ Heart Fail 8(3):510–518. https://doi.org/10.1161/CIRCHEARTFAILURE.114.001626 CrossRef

23.

Zhang XY, Shan QJ, Su YG, Yan J, Bao ZH, Gu X, Qiu JP, Qin SM, Xu J, Su H, Zhu H, Guo JF, Lu JP, Zou JG, Chen ML, Xu D, Cao KJ (2016) Efficacy of biventricular pacing on preventing heart failure in patients with high degree atrioventricular block (BIVPACE-AVB Trial). Zhonghua Xin Xue Guan Bing Za Zhi 44(4):331–337. https://doi.org/10.3760/cma.j.issn.0253-3758.2016.04.011 CrossRefPubMed

24.

Thambo JB, Bordachar P, Garrigue S, Lafitte S, Sanders P, Reuter S, Girardot R, Crepin D, Reant P, Roudaut R, Jais P, Haissaguerre M, Clementy J, Jimenez M (2004) Detrimental ventricular remodeling in patients with congenital complete heart block and chronic right ventricular apical pacing. Circulation 110(25):3766–3772. https://doi.org/10.1161/01.cir.0000150336.86033.8d CrossRefPubMed

25.

Wilkoff BL, Cook JR, Epstein AE, Greene HL, Hallstrom AP, Hsia H, Kutalek SP, Sharma A (2002) Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. Jama 288(24):3115–3123CrossRefPubMed

26.

Gillis AM, Purerfellner H, Israel CW, Sunthorn H, Kacet S, Anelli-Monti M, Tang F, Young M, Boriani G (2006) Reducing unnecessary right ventricular pacing with the managed ventricular pacing mode in patients with sinus node disease and AV block. Pacing Clin Electrophysiol 29(7):697–705. https://doi.org/10.1111/j.1540-8159.2006.00422.x CrossRefPubMed

27.

Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, Carson P, DiCarlo L, DeMets D, White BG, DeVries DW, Feldman AM (2004) Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 350(21):2140–2150. https://doi.org/10.1056/NEJMoa032423 CrossRefPubMed

28.

Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, Tavazzi L (2005) The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 352(15):1539–1549. https://doi.org/10.1056/NEJMoa050496 CrossRefPubMed

29.

Chatterjee NA, Upadhyay GA, Ellenbogen KA, Hayes DL, Singh JP (2012) Atrioventricular nodal ablation in atrial fibrillation: a meta-analysis of biventricular vs. right ventricular pacing mode. Eur J Heart Fail 14(6):661–667. https://doi.org/10.1093/eurjhf/hfs036 CrossRefPubMed

Title: Cardiac resynchronization therapy improves left ventricular remodeling and function compared with right ventricular pacing in patients with atrioventricular block
Authors: Dasheng Lu
Hao Zhang
Hongxiang Zhang
Publication date: 01-11-2018
Publisher: Springer US
Published in: Heart Failure Reviews / Issue 6/2018
Print ISSN: 1382-4147
Electronic ISSN: 1573-7322
DOI: https://doi.org/10.1007/s10741-018-9722-z

ACC 2024 Congress Coverage

Heart Failure Video

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Cardiac resynchronization therapy improves left ventricular remodeling and function compared with right ventricular pacing in patients with atrioventricular block

Abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 6/2018

Percutaneous support of the failing left and right ventricle—recommendations for the use of mechanical device therapy

Transcatheter valve interventions in heart failure: new answers to old questions

Electrical manipulation of the failing heart

Transcatheter aortic valve replacement in patients with severe aortic stenosis and heart failure

Implantable devices for heart failure monitoring and therapy

Left ventricular restoration devices post myocardial infarction

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page