Chronic Apical and Nonapical Right Ventricular Pacing in Patients with High-Grade Atrioventricular Block: Results of the Right Pace Study

Carmine Muto, Valeria Calvi, Giovanni Luca Botto, Domenico Pecora, Daniele Porcelli, Alessandro Costa, Gianfranco Ciaramitaro, Riccardo Airò Farulla, Anna Rago, Raimondo Calvanese, Marco Tullio Baratto, Albino Reggiani, Massimo Giammaria, Santina Patané, Monica Campari, Sergio Valsecchi, Giampiero Maglia, Carmine Muto, Valeria Calvi, Giovanni Luca Botto, Domenico Pecora, Daniele Porcelli, Alessandro Costa, Gianfranco Ciaramitaro, Riccardo Airò Farulla, Anna Rago, Raimondo Calvanese, Marco Tullio Baratto, Albino Reggiani, Massimo Giammaria, Santina Patané, Monica Campari, Sergio Valsecchi, Giampiero Maglia

Abstract

Objective: The aim of the study was to compare the two approaches to chronic right ventricular pacing currently adopted in clinical practice: right ventricular apical (RVA) and non-RVA pacing.

Background: Chronic RVA pacing is associated with an increased risk of atrial fibrillation, morbidity, and even mortality. Non-RVA pacing may yield more physiologic ventricular activation and provide potential long-term benefits and has recently been adopted as standard procedure at many implanting centers.

Methods: The Right Pace study was a multicenter, prospective, single-blind, nonrandomized trial involving 437 patients indicated for dual-chamber pacemaker implantation with a high percentage of RV pacing.

Results: RV lead-tip target location was the apex or the interventricular septum. RVA (274) and non-RVA patients (163) did not differ in baseline characteristics. During a median follow-up of 19 months (25th-75th percentiles, 13-25), 17 patients died. The rates of the primary outcome of death due to any cause or hospitalization for heart failure were comparable between the groups (log-rank test, p = 0.609), as were the rates of the composite of death due to any cause, hospitalization for heart failure, or an increase in left ventricular end-systolic volume ≥ 15% as compared with the baseline evaluation (secondary outcome, p = 0.703). After central adjudication of X-rays, comparison between adjudicated RVA (239 patients) and non-RVA (170 patients) confirmed the absence of difference in the rates of primary (p = 0.402) and secondary (p = 0.941) outcome.

Conclusions: In patients with indications for dual-chamber pacemaker who require a high percentage of ventricular stimulation, RVA or non-RVA pacing resulted in comparable outcomes. This study is registered with ClinicalTrials.gov (identifier: NCT01647490).

Figures

Figure 1
Figure 1
Kaplan-Meier estimate of time to death due to any cause or first hospitalization for heart failure (a), time to the composite of death due to any cause, hospitalization for heart failure, or a ≥15% increase in left ventricular end-systolic volume (b) and time to the first episode of documented atrial fibrillation (c).

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Source: PubMed

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