AV-optimized conduction system pacing for treatment of AV dromotropathy : a randomized, cross-over study

Zupan Mežnar, Anja (author), Mrak, Miha (author), Mullens, Wilfried (author), Štublar, Jernej (author), Ivanovski, Maja (author), Žižek, David (author)

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

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