Exercise capacity and N-terminal pro-brain natriuretic peptide levels with biventricular vs. right ventricular pacing for atrioventricular block: results from the PREVENT-HF German Substudy. Issue 1 (16th July 2013)

• Record Type: Journal Article
• Authors: Stockburger, Martin; de Teresa, Eduardo; Lamas, Gervasio; Desaga, Martin; Koenig, Carsten; Habedank, Dirk; Cobo, Erik; Navarro, Xavier; Wiegand, Uwe
• Is Part Of: Europace. Volume 16:Issue 1(2014:Jan.)
• Page Start: 63
• Page End: 70
• Publication Date: 2013-07-16
• Subjects: Cardiac resynchronization therapy -- Atrioventricular block -- Right ventricular pacing -- Biventricular pacing -- Heart failure -- Exercise testing -- N-terminal pro-brain natriuretic peptide (NT-proBNP); Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/eut217
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Aims: Previous studies showed unfavourable effects of right ventricular (RV) pacing. Ventricular pacing (VP), however, is required in many patients with atrioventricular (AV) block. The PREVENT-HF study explored left ventricular (LV) remodelling during RV vs. biventricular (BIV) pacing in AV block without advanced heart failure. The pre-specified PREVENT-HF German Substudy examined exercise capacity and N-terminal pro-brain natriuretic peptide (NT-proBNP). Methods and results: Patients with expected VP ≥80% were randomized to RV or BIV pacing. Endpoints were peak oxygen uptake (pVO2 ), oxygen uptake at the anaerobic threshold (VO2 AT), ventilatory efficiency (VE/VCO2 ), and logNT-proBNP. Considering crossover, intention to treat (ITT), and on-treatment (OT) analyses of covariance (ANCOVA) were performed. For exercise testing 44 (RV: 25, BIV: 19), and for NT-proBNP 53 patients (RV: 29, BIV: 24) were included. The ITT analysis revealed significant differences in pVO2 [ANCOVA effect 2.83 mL/kg/min, confidence interval (CI) 0.83–4.91, P = 0.007], VO2 AT (ANCOVA effect 2.14 mL/min/k, CI 0.14–4.15, P = 0.03), and VE/VCO2 (ANCOVA effect −5.46, CI −10.79 to −0.13, P = 0.04) favouring BIV randomization. The significant advantage in pVO2 persisted in OT analysis, while VO2 AT and VE/VCO2 showed trends favouring BIV pacing. LogNT-proBNP did not differ between groups. (ITT: ANCOVA effect 0.008, CI –0.40 to +0.41, P = 0.97; OT: ANCOVA effect –0.03, CI −0.44 to 0.30, P = 0.90). Conclusion: Our study suggests that BIV pacing produces better exercise capacity over 1 year compared with RV pacing in patients without advanced heart failure and AV block. In contrast, we observed no significant changes of NT-proBNP. Larger trials will allow appraising the clinical usefulness of BIV pacing in AV block. ClinicalTrials.gov Identifier: NCT00170326