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| Item Type: | Article |
|---|---|
| Title: | Right ventricular pacing is associated with impaired overall survival, but not with an increased incidence of ventricular tachyarrhythmias in routine cardioverter/defibrillator recipients with reservedly programmed pacing |
| Creators Name: | Stockburger, M. and Celebi, O. and Krebs, A. and Knaus, T. and Nitardy, A. and Habedank, D. and Dietz, R. |
| Abstract: | Aims Data from previous defibrillator studies raised concern about right ventricular pacing (RVP) promoting heart failure progression and mortality in implantable cardioverter/defibrillator (ICD) patients. The present observational study re-examined the association of RVP, survival, and ventricular tachyarrhythmias/ventricular fibrillation (VT/VF) in routine ICD patients with restrictively programmed pacing. Methods and results In 213 ICD patients [183 men, left ventricular ejection fraction (LVEF) 37 +/- 15%, follow-up 37 +/- 18 months, no advanced atrioventricular (AV) block], the RVP proportion, survival, and the time to a first appropriate VT/VF episode were assessed. Electrograms were validated and the overall survival was determined. The RVP prevalence was dichotomized at >/=30% (high RVP) vs. <30% (low RVP). High RVP (RVP 94%, n = 24) and low RVP (RVP 0%, n = 189) patients had similar LVEF, underlying heart disease, ICD indication, and medication. Multivariate Cox regression showed no difference in survival without appropriate VT/VF treatment [odds ratio (OR): 0.92, 95% confidence interval (CI): 0.41-2.04, P = 0.83]. Overall survival was significantly more favourable in low RVP patients (OR: 0.34, CI: 0.13-0.91, P = 0.03). Conclusion Frequent RVP is associated with impaired survival in ICD patients despite conservative pacing settings. Implantable cardioverter/defibrillator patients requiring concomitant bradycardia pacing should be cared for with particular attention to clinical worsening. Right ventricular pacing prevention and alternative modalities of ventricular pacing need prospective evaluation. |
| Keywords: | Right Ventricular Pacing, Cardioverter / Defibrillator, Overall Survival, Ventricular Tachyarrhythmia, Appropriate Treatment Episodes, Ventricular Pacing Prevention |
| Source: | Europace |
| ISSN: | 1099-5129 |
| Publisher: | Oxford University Press |
| Volume: | 11 |
| Number: | 7 |
| Page Range: | 924-930 |
| Date: | July 2009 |
| Official Publication: | https://doi.org/10.1093/europace/eup118 |
| PubMed: | View item in PubMed |
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