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Reducing Unnecessary Right Ventricular Pacing with the Managed Ventricular Pacing Mode in Patients with Sinus Node Disease and AV Block
Author(s) -
GILLIS ANNE M.,
PÜRERFELLNER HELMUT,
ISRAEL CARSTEN W.,
SUNTHORN HENRI,
KACET SALEM,
ANELLIMONTI MICHAEL,
TANG FENG,
YOUNG MARTIN,
BORIANI GIUSEPPE
Publication year - 2006
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2006.00422.x
Subject(s) - medicine , cardiology , ventricular pacing , bradycardia , crossover study , cardiac pacing , heart failure , sinus bradycardia , anesthesia , heart rate , blood pressure , alternative medicine , pathology , placebo
Background: Frequent and unnecessary right ventricular apical pacing increases the risk of atrial fibrillation or congestive heart failure. We evaluated a new pacing algorithm, managed ventricular pacing (MVP) which automatically changes modes between AAI/R and DDD/R in patients receiving pacemakers for symptomatic bradycardia.Methods: Patients were randomized to the MVP mode or DDD/R mode for 1 month and then crossed over to the alternate pacing modality for an additional month. On completion of the crossover phase, the pacing mode selected was individualized and patients were followed for an additional 4 months.Results: Of the 129 patients who successfully completed the crossover study, the cumulative percent ventricular pacing was significantly reduced in the MVP mode (median 1.4%) compared to the DDD/R mode (median 89.6%, 94.0% relative reduction; 95% CI 89.3–98.8%, P < 0.001). Patients with sinus node disease (SND, n = 51) when compared to patients with AV block (AVB) (n = 68) experienced a greater reduction in ventricular pacing with the MVP mode compared to the DDD/R mode (median relative reduction 99.1%; 95% CI 97.5–99.9% vs median relative reduction 60.1%; 95% CI 16.7–93.9% P < 0.001). The reduced percent ventricular pacing during MVP was sustained over longer term follow‐up.Conclusions: The majority of patients with a bradycardia indication for cardiac pacing do not require ventricular pacing most of the time. The MVP mode significantly reduces unnecessary right ventricular pacing. This mode benefits even patients with intermittent AVB and is sustained over longer term follow‐up.