Biventricular Pacing Versus Right Ventricular Pacing in Patients Supported With LVAD

• Published in: JACC. Clinical electrophysiology 2021-08, Vol.7 (8), p.1003-1009
• Main Authors: Chung, Ben B., Grinstein, Jonathan S., Imamura, Teruhiko, Kruse, Eric, Nguyen, Ann B., Narang, Nikhil, Holzhauser, Luise H., Burkhoff, Daniel, Lang, Roberto M., Sayer, Gabriel T., Uriel, Nir Y.
• Format: Article
• Language: English
• Subjects: biventricular pacing; cardiac resynchronization; CRT; left ventricular assist device; LVAD; VAD
• ISSN: 2405-500X; 2405-5018
• DOI: 10.1016/j.jacep.2021.01.016

This study sought to evaluate the effects of right ventricular (RV) pacing versus biventricular (BiV) pacing on quality of life, functional status, and arrhythmias in LVAD patients. Cardiac resynchronization therapy (CRT) and left ventricular assist devices (LVADs) independently improve outcomes in heart failure patients, but the effects of combining these therapies remains unknown. We present the first prospective randomized study evaluating the effects of RV versus BiV pacing on quality of life, functional status, and arrhythmias in LVAD patients. In this prospective randomized crossover study, LVAD patients with prior CRT devices were alternated on RV and BiV pacing for planned 7–14-day periods. Ambulatory step count, 6-minute walk test distance, Kansas City Cardiomyopathy Questionnaire scores, arrhythmia burden, CRT lead function, and echocardiographic data were collected with each pacing mode. Thirty patients were enrolled, with a median age of 65 years, 67% male, and mean duration of LVAD support of 309 days. Compared with BiV pacing, RV-only pacing resulted in 29% higher mean daily step count, 11% higher 6-minute walk test distance, and 7% improved KCCQ-12 score (all p