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Minimizing right ventricular pacing in pacemaker patients with intact and compromised atrioventricular conduction

Results from the EVITA Trial

Reduktion rechtsventrikulärer Stimulation bei Patienten mit intakter und kompromittierter Leitung

Ergebnisse der EVITA-Studie

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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.

Zusammenfassung

Hintergrund

Unnötige ventrikuläre Stimulation ist mit einer erhöhten Mortalität und Morbidität vergesellschaftet. In den vergangenen Jahren wurden verschiedene Algorithmen zur Reduktion der ventrikulären Stimulation entwickelt.

Fragestellung

Ziel der vorliegenden Studie war es, die Effektivität des VIP-Algorithmus bei Patienten mit intakter (AVi) und kompromittierter (AVc) atrioventrikulärer Leitung zu testen.

Material und Methoden

EVITA war eine prospektive und randomisierte Multicenterstudie (Trials.gov Identifier: NCT00366158). Insgesamt wurden 389 Patienten in eine AVc- (n = 140/132 VIP OFF/VIP On) oder AVi Gruppe (n = 54/63 VIP OFF/VIP ON) randomisiert. Einen Monat nach Implantation erfolgte eine Testung der AV-Knotenleitung(AVc: PR/AR-Intervall > 210 ms). Die Nachsorgen wurden 6 and 12 Monate nach DDD-Schrittmacherimplantation durchgeführt.

Ergebnisse

Bei AVi- and AVc-Patienten führte die Initiierung des VIP-Algorithmus zu einer signifikanten Reduktion ventrikulärer Stimulation (AVi: 53 ± 38 vs. 9 ± 21 %, p = 0,0001; AVc: 79 ± 31 vs. 28 ± 35 %, p = 0,0001). Die DDD-Schrittmacherimplantation per se sorgte für eine signifikanten Reduktion von Vorhofflimmern bei VIP ON- (AVi 27 vs. 0 %, p < 0,0001; AVc 29 vs. 3 % p < 0,0001) und VIP OFF-Patienten (AVi 43 vs. 4 %, p < 0,0001; AVc 33 vs. 3 %p < 0,0001), ohne signifikanten Unterschiede im direkten Vergleich der Gruppen (p > 0,05). In der AVc-Gruppe reduzierte die Aktivierung des VIP Algorithmus die Inzidenz von unerwarteten Ereignissensignifikant (AE). Die Gesamtmortalität war bei VIP ON (n = 5) und VIP OFF (n = 4,) Patienten nicht signifikant unterschiedlich (p > 0,05).

Schlußfolgerung

Die AV-Such-Hysterese (VIP) reduziert signifikant die ventrikuläre Stimulation bei Patienten mit normaler wie auch kompromittierter atrioventrikulärer Leitung.

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Acknowledgment

This study was financially supported by St. Jude.

Author information

Authors and Affiliations

  1. Department of Cardiology, Diakonieklinikum Schwäbisch Hall/Klinikum Crailsheim, Diakoniestrasse 12, 74523, Schwäbisch Hall, Germany

    A. Bauer

  2. AZ Sint Dimpna, Geel, Belgium

    J. Vermeulen

  3. Helsinki University Central Hospital, Helsinki, Finland

    L. Toivonen

  4. Mustamae Hospital, Tallin, Estonia

    J. Voitk

  5. Russels-Hall Hospital, Dudley, United Kingdom

    C. Barr

  6. O.L. Vrouwziekenhuis Campus, Asse, Belgium

    P. Peytchev

Authors
  1. A. Bauer
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  2. J. Vermeulen
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  3. L. Toivonen
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  4. J. Voitk
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  5. C. Barr
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Corresponding author

Correspondence to A. Bauer.

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Conflicts of interest

A. Bauer received speaker honorarium from Medtronic and St. Jude. C. Barr receives consulting fees from Cameron Health and fellowships funded by Biotronic, St. Jude and Medtronic. L.Toivonen, J. Voitk, and P. Peytchev declare that there are no conflicts of interest.

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975 (in its most recently amended version). Informed consent was obtained from all patients included in the study.

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Bauer, A., Vermeulen, J., Toivonen, L. et al. Minimizing right ventricular pacing in pacemaker patients with intact and compromised atrioventricular conduction. Herzschr Elektrophys 26, 359–366 (2015). https://doi.org/10.1007/s00399-015-0394-2

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  • DOI: https://doi.org/10.1007/s00399-015-0394-2

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