Chronic Apical and Nonapical Right Ventricular Pacing in Patients with High-Grade Atrioventricular Block: Results of the Right Pace Study

• Published in: BioMed research international 2018-01, Vol.2018 (2018), p.1-7
• Main Authors: Rago, Anna, Calvanese, Raimondo, Reggiani, Albino, Giammaria, Massimo, Patané, Santina, Campari, Monica, Valsecchi, Sergio, Maglia, Giampiero, Airò Farulla, Riccardo, Ciaramitaro, Gianfranco, Costa, Alessandro, Porcelli, Daniele, Pecora, Domenico, Botto, Giovanni Luca, Calvi, Valeria, Muto, Carmine, Baratto, Marco Tullio
• Format: Article
• Language: English
• Subjects: Adjudication; Aged; Aged, 80 and over; Atrial fibrillation; Atrioventricular Block; Biomedical research; Cardiac arrhythmia; Cardiac Pacing, Artificial; Cardiology; Cardiovascular disease; Care and treatment; Clinical medicine; Clinical Study; Female; Fibrillation; Health aspects; Heart; Heart diseases; Heart failure; Heart Ventricles; Humans; Implantation; Male; Medical equipment and supplies industry; Medical test kit industry; Morbidity; Mortality; Patients; Prospective Studies; Quality of Life; Rank tests; Rankings; Reproducibility of Results; Septum; Single-Blind Method; Treatment Outcome; United States; Variables; Ventricle; X-rays
• ISSN: 2314-6133; 2314-6141
• DOI: 10.1155/2018/1404659

Objective. The aim of the study was to compare the two approaches to chronic right ventricular pacing currently adopted in clinical practice: right ventricular apical (RVA) and non-RVA pacing. Background. Chronic RVA pacing is associated with an increased risk of atrial fibrillation, morbidity, and even mortality. Non-RVA pacing may yield more physiologic ventricular activation and provide potential long-term benefits and has recently been adopted as standard procedure at many implanting centers. Methods. The Right Pace study was a multicenter, prospective, single-blind, nonrandomized trial involving 437 patients indicated for dual-chamber pacemaker implantation with a high percentage of RV pacing. Results. RV lead-tip target location was the apex or the interventricular septum. RVA (274) and non-RVA patients (163) did not differ in baseline characteristics. During a median follow-up of 19 months (25th–75th percentiles, 13–25), 17 patients died. The rates of the primary outcome of death due to any cause or hospitalization for heart failure were comparable between the groups (log-rank test, p=0.609), as were the rates of the composite of death due to any cause, hospitalization for heart failure, or an increase in left ventricular end-systolic volume ≥ 15% as compared with the baseline evaluation (secondary outcome, p=0.703). After central adjudication of X-rays, comparison between adjudicated RVA (239 patients) and non-RVA (170 patients) confirmed the absence of difference in the rates of primary (p=0.402) and secondary (p=0.941) outcome. Conclusions. In patients with indications for dual-chamber pacemaker who require a high percentage of ventricular stimulation, RVA or non-RVA pacing resulted in comparable outcomes. This study is registered with ClinicalTrials.gov (identifier: NCT01647490).