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Long‐term follow‐up results of the Pacing to Avoid Cardiac Enlargement ( PACE ) trial
Author(s) -
Yu CheukMan,
Fang Fang,
Luo XiuXia,
Zhang Qing,
Azlan Hussin,
Razali Omar
Publication year - 2014
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.157
Subject(s) - medicine , ejection fraction , bradycardia , heart failure , clinical endpoint , cardiology , randomized controlled trial , adverse effect , cardiac function curve , heart rate , blood pressure
Aims We report the results of long‐term follow‐up of the Pacing to Avoid Cardiac Enlargement ( PACE ) trial, a prospective, double‐blinded, randomized, multicentre study that confirmed the superiority of biventricular ( BiV ) pacing compared with right ventricular apical ( RVA ) pacing in prevention of LV adverse remodelling and deterioration of systolic function at 1 and 2 years. Methods and results Patients with bradycardia and preserved LVEF were randomized to receive RVA ( n = 88) or BiV pacing ( n = 89). Co‐primary endpoints were LV end‐systolic volume ( LVESV ) and LVEF measured by echocardiography. There were 149 patients who had extended follow‐up, with a mean duration of 4.8 ± 1.5 years (2.5–7.8 years). The primary endpoint analyses were performed in 146 patients (74 in the RVA group and 72 in the BiV group). In the RVA pacing group, the LVEF decreased while the LVESV increased progressively at follow‐up, but remained unchanged in the BiV pacing group. The differences in LVEF between the RVA and BiV groups were –6.3, –9.2, and –10.7% at 1‐year, 2‐year, and long‐term follow‐up, respectively (all P < 0.001). The corresponding differences in LVESV were +7.4, +9.9, and +13.1 mL , respectively (all P < 0.001). The deleterious effects of RVA pacing consistently occurred in all the pre‐defined subgroups. Furthermore, patients with RVA pacing had a significantly higher prevalence of heart failure hospitalization than the BiV group (23.9% vs. 14.6%, log‐rank χ 2 = 7.55, P = 0.006). Conclusion Left ventricular adverse remodelling and deterioration of systolic function continued at long‐term follow‐up in patients with RVA pacing; this deterioration was prevented by the use of BiV pacing. Also, heart failure hospitalization was more prevalent in the RVA pacing group. Trial registration CUHK_CCT00037.