Document Detail

Long-term implications of cumulative right ventricular pacing among patients with an implantable cardioverter-defibrillator.
MedLine Citation:
PMID:  21044897     Owner:  NLM     Status:  In-Data-Review    
BACKGROUND: Limited data regarding the effect of right ventricular pacing (RVP) on long-term survival following implantable cardioverter-defibrillator (ICD) implantation are available.
OBJECTIVE: The purpose of this study was to evaluate the effect of RVP on the long-term survival benefit of primary ICD therapy.
METHODS: Mortality data were obtained for all patients enrolled in the Multicenter Automatic Defibrillator Trial-II (MADIT-II) during an extended follow-up period of 8 years. The cumulative percent RVP during the trial was categorized as low (≤50% [n = 369]) and high (>50% [n = 198]). The benefit of ICD versus non-ICD therapy (n = 490) was evaluated in the two pacing categories during the early (0-3 years) and late (4-8 years) phases of the extended follow-up period.
RESULTS: During the early phase of the extended follow-up period, ICD therapy was associated with similar benefits in the low-RVP and high-RVP subgroups (hazard ratio [HR] = 0.35 and 0.38, respectively, P <.001 for both). In contrast, during the late phase, the long-term survival benefit of the ICD was maintained among patients with low RVP (HR = 0.60, P <.001) and attenuated among those with the high RVP (HR = 0.89, P = .45). An increased risk for late mortality associated with high versus low RVP was evident only among patients without left bundle branch [LBBB] at enrollment (HR = 1.63, P = .002).
CONCLUSION: Among ICD recipients, high RVP is associated with a significant increase in the risk of long-term mortality and with attenuated device efficacy. The deleterious effects of RVP are pronounced mainly in non-LBBB patients, suggesting a possible role for combined cardiac resynchronization-defibrillator therapy in this population.
Alon Barsheshet; Arthur J Moss; Scott McNitt; Christian Jons; Michael Glikson; Helmut U Klein; David T Huang; Jonathan S Steinberg; Mary W Brown; Wojciech Zareba; Ilan Goldenberg;
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Publication Detail:
Type:  Journal Article     Date:  2010-10-29
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  8     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-01-31     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  212-8     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
Cardiology Division, University of Rochester Medical Center, Rochester, New York.
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