Authors
Lozano I, Bocchiardo M, Achtelik M, et al.
Title
Impact of Biventricular Pacing on Mortality in a Randomized Crossover Study of Patients with Heart Failure and Ventricular Arrhythmias
References
Pacing Clin Electrophysiol 2000; 23(11 pt 2): 1711-2
Background
Previous literature had suggested improvements in acute hemodynamic performance, exercise capacity, and quality of life with biventricular pacing in patients with heart failure and inter- and intraventricular conduction delays. The impact on mortality had not been established at the time of this trial.
Purpose
To determine whether the addition of biventricular pacing to conventional ICD therapy impacted all-cause mortality in a patient population with heart failure and ventricular tachyarryhythmias.
Design
Randomized trial; no report on blinding protocols 222 patients with symptomatic heart failure (NYHA II-IV), an indication for an ICD, LVEF ≤ 35%, QRS width > 120 ms, and optimal medical therapy for heart failure
Exclusion Criteria
Indication for antibradycardia pacing Atrial tachyarrythmias refractory to chronic drug therapy
Follow-Up
3 months
Treatment Regimen
All patients received an ICD capable of BiV pacing, right atrial pacing/sensing lead, cardioversion/defibrillation lead, and a left ventricular pacing/sensing lead 30-day post-implant recovery period with pacing programmed Off Randomized to BiV pacing or no pacing for 3 months, then crossed over to opposite mode BiV pacing in atrial synchronous, ventricular pacing mode
Results
All cause mortality: BiV pacing (4.6%) vs no pacing (8.8%) Kaplan-Meier survival rate: BiV pacing (93 ± 4%) vs no pacing (86 ± 6%) (p = 0.18)
Summary
There is no adverse effect on survival with BiV pacing, with a trend towards benefit (which was not statistically significant in this study).