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

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

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.

• Jezik: Angleški jezik
• Ključne besede: AV coupling, AV dromotropathy, AV dyssynchrony, conduction system pacing, first‐degree AV block
• Vrsta gradiva: Članek v reviji
• Tipologija: 1.01 - Izvirni znanstveni članek
• Organizacija: MF - Medicinska fakulteta
• Status publikacije: Objavljeno
• Različica publikacije: Objavljena publikacija
• Leto izida: 2024
• Št. strani: Str. 1340-1350
• Številčenje: Vol. 35, iss. 7
• PID: 20.500.12556/RUL-160166
• UDK: 616.1:602.621
• ISSN pri članku: 1045-3873
• DOI: 10.1111/jce.16268
• COBISS.SI-ID: 203663107
• Datum objave v RUL: 22.08.2024

Gradivo je del revije

• Naslov: Journal of cardiovascular electrophysiology
• Skrajšan naslov: J. cardiovasc. electrophysiol.
• Založnik: Wiley
• ISSN: 1045-3873
• COBISS.SI-ID: 515092

Licence

• Licenca: CC BY-NC-ND 4.0, Creative Commons Priznanje avtorstva-Nekomercialno-Brez predelav 4.0 Mednarodna
• Povezava: http://creativecommons.org/licenses/by-nc-nd/4.0/deed.sl
• Opis: Najbolj omejujoča licenca Creative Commons. Uporabniki lahko prenesejo in delijo delo v nekomercialne namene in ga ne smejo uporabiti za nobene druge namene.

Projekti

• Financer: Drugi - Drug financer ali več financerjev
• Program financ.: University Medical Center Ljubljana
• Številka projekta: TP20190093