Document Detail


Effect of pacing for soft indications on mortality and heart failure in the dual chamber and VVI implantable defibrillator (DAVID) trial.
MedLine Citation:
PMID:  18684279     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The dual chamber and VVI implantable defibrillator (DAVID) trial demonstrated that dual chamber (DDDR) pacing in defibrillator candidates with impaired ventricular function and no established indication for pacing resulted in worsened congestive heart failure (CHF) or death. Many patients had abnormalities for which pacing is often advocated to improve the management of ventricular dysfunction. OBJECTIVES: Evaluate the impact and interaction of nonessential but potentially justifiable reasons to pace ("soft indications"), together with pacing mode, on outcome. METHODS: DAVID patients were stratified by those with and without "soft indications" for pacing (rate < 60 beats/min or first-degree atrioventricular block) (n = 169; n = 335, respectively). This analysis also stratified patients by normal and abnormal QRS conduction (QRS >or= 110 ms), who were previously found to be affected differently by DDDR pacing. Groups were analyzed according to the combined endpoint of mortality or CHF hospitalization. RESULTS: When assigned to treatment that promoted pacing (DDDR), the incidence of death or CHF tended to be higher in patient subgroups with and without "soft indications," consistent with results from DAVID. Patients with, compared to those without, these abnormalities neither benefited nor were less adversely affected when actively paced. The presence or absence of "soft indications" also provided no additional explanation for the differing outcomes in patient cohorts with and without abnormal QRS conduction. CONCLUSIONS: Sinus bradycardia or first-degree atrioventricular block did not ameliorate the poor outcomes associated with dual-chamber compared with VVI pacing, and do not justify conventional dual-chamber pacing in defibrillator recipients with ventricular dysfunction.
Authors:
Steven P Kutalek; Arjun D Sharma; Michael J McWilliams; Bruce L Wilkoff; Anna Leonen; Alfred P Hallstrom; Peter J Kudenchuk;
Related Documents :
18242549 - Sequential dual chamber extrastimulation: a novel pacing maneuver to identify the prese...
11498649 - Mechanisms and efficacy of lv pre-excitation for patients with heart failure and supra-...
18258319 - Reversible left ventricular dyssynchrony and heart failure induced by right ventricular...
18855129 - Novel visualization of intracardiac pacing lead extractions: methodologies performed wi...
3711479 - Left ventricular endocardial activation during right ventricular pacing: effect of unde...
8486879 - An audit of cardiac pacing in the elderly: effect of myocardial infarction on outcome.
12771669 - Preconditioning and the oxidants of sudden death.
18425809 - Structural remodeling of nucleus ambiguus projections to cardiac ganglia following chro...
22935509 - Undersampled cine 3d tagging for rapid assessment of cardiac motion.
Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  31     ISSN:  1540-8159     ISO Abbreviation:  Pacing Clin Electrophysiol     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-08-07     Completed Date:  2008-10-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  828-37     Citation Subset:  IM    
Affiliation:
Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Aged
Cardiac Pacing, Artificial / mortality*
Defibrillators, Implantable / statistics & numerical data*
Electric Countershock / mortality*
Female
Heart Failure / mortality*,  prevention & control*
Humans
Incidence
Male
Middle Aged
Prognosis
Risk Assessment / methods*
Risk Factors
Single-Blind Method
Survival Analysis
Survival Rate
Treatment Outcome
United States

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  A radial global dyssynchrony index as predictor of left ventricular reverse remodeling after cardiac...
Next Document:  Left ventricular diastolic filling prior to cardiac resynchronization therapy: implications for atri...