Erschienen in:
01.12.2015 | Original contribution
Minimizing right ventricular pacing in pacemaker patients with intact and compromised atrioventricular conduction
Results from the EVITA Trial
verfasst von:
Prof. Dr. A. Bauer, J. Vermeulen, L. Toivonen, J. Voitk, C. Barr, P. Peytchev
Erschienen in:
Herzschrittmachertherapie + Elektrophysiologie
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Ausgabe 4/2015
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Abstract
Introduction
Unnecessary ventricular pacing is associated with increased morbidity and mortality. Over the years different algorithms have been developed to reduce right ventricular pacing.
Objectives
Goal of the present study was to test the efficacy of the ventricular intrinsic preference (VIP) algorithm in patients with atrioventricular intact (AVi) and atrioventricular compromised (AVc) AV-conduction.
Methods
Evaluation of VIP feature in pacemaker patients (EVITA) was a multicenter, prospective, randomized trial (Trials.gov Identifier: NCT00366158). In total, 389 patients were randomized to AVc group: n = 140/132 VIP OFF/VIP On, AVi group: n = 54/63 VIP OFF/VIP ON). One-month post-implantation AV conduction testing (AVc: PR/AR interval > 210 ms) was performed. Follow-up visits occurred 6 and 12 months after DDD-pacemaker implantation.
Results
In AVi and AVc-patients initiation of the VIP feature significantly reduced incidence of ventricular pacing (AVi: 53 ± 38 vs. 9 ± 21 %, p = 0.0001; AVc: 79 ± 31 vs. 28 ± 35 %, p = 0.0001). DDD-pacemaker implantation per se significantly reduced incidence of AF in VIP ON (AVi 27 vs. 0 %, p < 0.0001; AVc 29 vs. 3 %, p < 0.0001) and VIP OFF patients (AVi 43 vs. 4 %, p < 0.0001; AVc 33 vs. 3 %, p < 0.0001), without significant differences between VIP ON and OFF groups (p > 0.05). In the AVc group activation of VIP significantly reduced incidence of adverse events (AE). All-cause mortality was not significantly different in VIP ON (n = 5) and VIP OFF (n = 4, p > 0.05) patients.
Conclusion
AV search hysteresis (VIP) markedly reduces ventricular pacing both in patients with normal AV conduction and in patients with prolonged PR interval or intermittent AV block.