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Managed ventricular pacing compared with conventional dual-chamber pacing for elective replacement in chronically paced patients:results of the Prefer for Elective Replacement Managed Ventricular Pacing randomized study
- Source :
- Botto, G L, Ricci, R P, Bénézet, J M, Nielsen, J C, De Roy, L, Piot, O, Quesada, A, Quaglione, R, Vaccari, D, Garutti, C, Vainer, L, Kozák, M & PreFER MVP Investigators 2014, ' Managed ventricular pacing compared with conventional dual-chamber pacing for elective replacement in chronically paced patients : results of the Prefer for Elective Replacement Managed Ventricular Pacing randomized study ', Heart Rhythm, vol. 11, no. 6, pp. 992-1000 . https://doi.org/10.1016/j.hrthm.2014.01.011
- Publication Year :
- 2014
-
Abstract
- BACKGROUND: Several studies have shown that unnecessary right ventricular pacing has detrimental effects.OBJECTIVE: To evaluate whether minimization of ventricular pacing as compared with standard dual-chamber pacing (DDD) improves clinical outcomes in patients referred for pacemaker or implantable cardioverter-defibrillator (ICD) replacement.METHODS: In an international single-blind, multicenter, randomized controlled trial, we compared DDD with managed ventricular pacing (MVP), a pacing mode developed to minimize ventricular pacing by promoting intrinsic atrioventricular conduction. We included patients referred for device replacement with >40% ventricular pacing, no cardiac resynchronization therapy upgrade indication, no permanent atrial fibrillation (AF), and no permanent complete atrioventricular block. Follow-up was for 2 years. The primary end point was cardiovascular hospitalization. The intention-to-treat analysis was performed by using Kaplan-Meier method and the log-rank test.RESULTS: We randomized 605 patients (556 referred for pacemaker and 49 referred for ICD replacement; mean age 75 ± 11 years; 365 [60%] men, at 7.7 ± 3.3 years from first device implantation) to MVP (n = 299) or DDD (n = 306). We found no significant differences in the primary end point cardiovascular hospitalization (MVP: 16.3% vs DDD: 14.5%; P = .72) and the secondary end point persistent AF (MVP: 15.4% vs DDD: 11.2%; P = .08), permanent AF (MVP: 4.1% vs DDD: 3.1%; P = .44), and composite of death and cardiovascular hospitalization (MVP: 23.9% vs DDD: 20.2%; P = .48). MVP reduced right ventricular pacing (median 5% vs 86%; Wilcoxon, P < .0001) as compared with DDD.CONCLUSIONS: In patients referred for pacemaker and ICD replacement with clinically well-tolerated long-term exposure to >40% ventricular pacing in the ventricle, a strategy to minimize ventricular pacing is not superior to standard DDD in reducing incidence of cardiovascular hospitalizations.
- Subjects :
- Male
Pacemaker, Artificial
medicine.medical_specialty
medicine.medical_treatment
Cardiac resynchronization therapy
Interquartile range
Physiology (medical)
Internal medicine
Humans
Medicine
Aged
Aged, 80 and over
Ejection fraction
business.industry
Cardiac Pacing, Artificial
Atrial fibrillation
Middle Aged
medicine.disease
Implantable cardioverter-defibrillator
Defibrillators, Implantable
Intention to Treat Analysis
Treatment Outcome
medicine.anatomical_structure
Ventricle
Heart failure
Ventricular Fibrillation
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Atrioventricular block
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- Botto, G L, Ricci, R P, Bénézet, J M, Nielsen, J C, De Roy, L, Piot, O, Quesada, A, Quaglione, R, Vaccari, D, Garutti, C, Vainer, L, Kozák, M & PreFER MVP Investigators 2014, ' Managed ventricular pacing compared with conventional dual-chamber pacing for elective replacement in chronically paced patients : results of the Prefer for Elective Replacement Managed Ventricular Pacing randomized study ', Heart Rhythm, vol. 11, no. 6, pp. 992-1000 . https://doi.org/10.1016/j.hrthm.2014.01.011
- Accession number :
- edsair.doi.dedup.....7b6e91f15584a2c16bf2efaabd603098