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AV-optimized conduction system pacing for treatment of AV dromotropathy : a randomized, cross-over study
ID
Zupan, Anja
(
Author
),
ID
Mrak, Miha
(
Author
),
ID
Mullens, Wilfried
(
Author
),
ID
Štublar, Jernej
(
Author
),
ID
Ivanovski, Maja
(
Author
),
ID
Žižek, David
(
Author
)
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https://onlinelibrary.wiley.com/doi/10.1111/jce.16268
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Abstract
Background: Severe first-degree atrioventricular (AV) block may produce symptoms similar to heart failure due to AV dyssynchrony, a syndrome termed AV dromotropathy. According to guidelines, it should be considered for permanent pacemaker implantation, yet evidence supporting this treatment is scarce. Objectives: This study aimed to determine the impact of AV-optimized conduction system pacing (CSP) in patients with symptomatic severe first-degree AV block and echocardiographic signs of AV dyssynchrony. Methods: Patients with symptomatic first-degree AV block (PR > 250 ms), preserved left ventricular ejection fraction, narrow QRS, and AV dyssynchrony were included in the study. In a single-blind cross-over design, patients were randomized to AV sequential CSP or backup VVI pacing with a base rate of 40 bpm. We compared exercise capacity, echocardiographic parameters, and symptom occurrence at the end of 3 months of each period. Results: Fourteen patients completed the study. During the AV-optimized CSP compared to the backup pacing period, patients achieved a higher workload on exercise test (147.2 ± 50.9 vs. 140.7 ± 55.8 W; p = .032), with a trend towards higher peak VO2 (23.3 ± 7.1 vs. 22.8 ± 7.1 mL/min/kg; p = .224), and higher left ventricular stroke volume (LVSV 74.5 ± 13.8 vs. 66.4 ± 12.5 mL; p < .001). Symptomatic improvement was recorded, with fewer patients reporting general tiredness and 71% of patients preferring the AV-optimized CSP (p = .008). Conclusions: AV-optimized CSP could improve symptoms, exercise capacity and LVSV in patients with severe first-degree AV block.
Language:
English
Keywords:
AV coupling
,
AV dromotropathy
,
AV dyssynchrony
,
conduction system pacing
,
first‐degree AV block
Work type:
Article
Typology:
1.01 - Original Scientific Article
Organization:
MF - Faculty of Medicine
Publication status:
Published
Publication version:
Version of Record
Year:
2024
Number of pages:
Str. 1340-1350
Numbering:
Vol. 35, iss. 7
PID:
20.500.12556/RUL-160166
UDC:
616.1:602.621
ISSN on article:
1045-3873
DOI:
10.1111/jce.16268
COBISS.SI-ID:
203663107
Publication date in RUL:
22.08.2024
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15
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3
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Record is a part of a journal
Title:
Journal of cardiovascular electrophysiology
Shortened title:
J. cardiovasc. electrophysiol.
Publisher:
Wiley
ISSN:
1045-3873
COBISS.SI-ID:
515092
Licences
License:
CC BY-NC-ND 4.0, Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
Link:
http://creativecommons.org/licenses/by-nc-nd/4.0/
Description:
The most restrictive Creative Commons license. This only allows people to download and share the work for no commercial gain and for no other purposes.
Projects
Funder:
Other - Other funder or multiple funders
Funding programme:
University Medical Center Ljubljana
Project number:
TP20190093
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