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

doi:10.1093/europace/euad065

Arrhythmias & electrophysiology

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

EuropacePublished 21 Mar 2023Pooled analysis of two prospective observational studies

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Authors' 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.

Study context

Population: Bradycardia patients treated with dual-chamber pacing (USA, Europe, Africa, Asia)50% with AV hysteresis (AVH)
Participants: 2,592 patients

Comparison: Dual-chamber pacing with atrioventricular (AV) hysteresis vs standard pacing with fixed AV delays
Outcome: Incidence of HF hospitalisation, persistent AF and cardiac death
Follow-up: 1 year

Methodological detailsmultinational (BRADYCARE I and II), Pooled data from BRADYCARE I (USA) and BRADYCARE II (Europe, Africa, Asia); patients with complete 1-year clinical and device data analysed

Multinational (BRADYCARE I and II)
Pooled data from BRADYCARE I (USA) and BRADYCARE II (Europe, Africa, Asia); patients with complete 1-year clinical and device data analysed

Pooled result

As reported in the abstract

1-year incidence of HFH, persistent AF and cardiac death

Relative risk reduction (RRR)

57.5%

P = 0.002

Heart failure hospitalizations (HFH)

RRR

31.1%

P = 0.028

persistent atrial fibrillation (AF)

AVH

HFH: 1.3%
Persistent AF: 5.3%

Standard pacing

HFH: 3.1%
Persistent AF: 7.7%

HFH

AVH1.3%

Standard pacing3.1%

Persistent AF

AVH5.3%

Standard pacing7.7%

Cardiac mortality not different between groups (1.0% vs. 1.4%, RRR = 27.8%): P = 0.366

Further pooled results

Ventricular pacing percentage (all patients and by pacing indication) AVH median 7% · Standard pacing median 75%

SND

AVH3%

Standard pacing44%

AVB

AVH25%

Standard pacing98%

Other indications

AVH3%

Standard pacing47%

Ventricular pacing percentage (all patients and by pacing indication): P < 0.001 for all

Original publication

Avoiding unnecessary ventricular pacing is associated with reduced incidence of heart failure hospitalizations and persistent atrial fibrillation in pacemaker patients. Europace. Published 21 March 2023. doi:10.1093/europace/euad065

Read the original article ↗

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