Avoiding unnecessary ventricular pacing is associated with reduced incidence of heart failure hospitalizations and persistent atrial fibrillation in pacemaker patients

Arnold M, Richards M, D'Onofrio A, Faulknier B, Gulizia M, Thakur R, Sakata Y, Lin W, Pollastrelli A, Grammatico A, Auricchio A, Boriani G, Bradycare I Ii Study Investigators (2023)

Publication Type: Journal article

Publication year: 2023

Journal

Europace Oxford University Press

DOI: 10.1093/europace/euad065

Abstract

Aims In bradycardia patients treated with dual-chamber pacing, we aimed to evaluate whether pacing with atrioventricular (AV) delay management [AV hysteresis (AVH)], compared with standard pacing with fixed AV delays, reduces unnecessary ventricular pacing percentage (VPP) and is associated with better clinical outcomes. Main study endpoints were the incidence of heart failure hospitalizations (HFH), persistent atrial fibrillation (AF), and cardiac death. Methods and results Data from two identical prospective observational studies, BRADYCARE I in the USA and BRADYCARE II in Europe, Africa, and Asia, were pooled. Overall, 2592 patients (75 +/- 10 years, 45.1% female, 50% with AVH) had complete clinical and device data at 1-year follow-up and were analysed. Primary pacing indication was sinus node disease (SND) in 1177 (45.4%), AV block (AVB) in 974 (37.6%), and other indications in 441 (17.0%) patients. Pacing with AVH, compared with standard pacing, was associated with a lower 1-year incidence of HFH [1.3% vs. 3.1%, relative risk reduction (RRR) 57.5%, P = 0.002] and of persistent AF (5.3% vs. 7.7%, RRR = 31.1%, P = 0.028). Cardiac mortality was not different between groups (1.0% vs. 1.4%, RRR = 27.8%, P = 0.366). Pacing with AVH, compared with standard pacing, was associated with a lower (P < 0.001) median VPP in all patients (7% vs. 75%), in SND (3% vs. 44%), in AVB (25% vs. 98%), and in patients with other pacing indications (3% vs. 47%). Conclusion Cardiac pacing with AV delay management via AVH is associated with reduced 1-year incidence of HFH and persistent AF, most likely due to a reduction in VPP compared to standard pacing.

Authors with CRIS profile

Martin Arnold Department of Medicine 2 – Cardiology and Angiology

Involved external institutions

Yakima Valley Memorial Heart & Vascular US United States (USA) (US) Ospedale Monaldi IT Italy (IT) West Virginia University (WVU) US United States (USA) (US) Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Garibaldi IT Italy (IT) Thoracic & Cardiovascular Institute - Lansing US United States (USA) (US) Osaka University Hospital / 大阪大学医学部附属病院 JP Japan (JP) Abbott US United States (USA) (US) ABBOTT ITALIA IT Italy (IT) Cardiocentro Ticino CH Switzerland (CH) Università degli Studi di Modena e Reggio Emilia (UNIMORE) IT Italy (IT)

How to cite

APA:

Arnold, M., Richards, M., D'Onofrio, A., Faulknier, B., Gulizia, M., Thakur, R.,... Bradycare I Ii Study Investigators, . (2023). Avoiding unnecessary ventricular pacing is associated with reduced incidence of heart failure hospitalizations and persistent atrial fibrillation in pacemaker patients. Europace. https://dx.doi.org/10.1093/europace/euad065

MLA:

Arnold, Martin, et al. "Avoiding unnecessary ventricular pacing is associated with reduced incidence of heart failure hospitalizations and persistent atrial fibrillation in pacemaker patients." Europace (2023).

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