Reduction of unnecessary right ventricular pacing by managed ventricular pacing and search AV+ algorithms in pacemaker patients: 12-month follow-up results of a randomized study

Abstract

Aims The present study was to assess the reduction of right ventricular pacing (RVP) by pacemaker algorithms of Managed Ventricular Pacing (MVP) and Search AV+ (SAV+) interval over a period of 12 months. Methods and results A total of 385 patients indicated for a dual-chamber pacemaker (DC-PM) were enrolled in the prospective, randomized COMPARE study at 29 centres in China between June 2009 and April 2011. Patients implanted with DC-PMs were randomized in a 1: 1 ratio to the MVP group or the SAV+ group. The percentage of VP (%VP) was obtained from the device diagnostic data at 1-, 6-, and 12-month follow-ups and was expressed as the median %VP over all beats in patients with sinus node dysfunction (SND) and atrioventricular block (AVB) excluding persistent third-degree AVB. Of 385 enrolled patients, 253 had SND and 72 had AVB. The %VP in the MVP group was significantly lower than that in the SAV+ group at 1-, 6-, and 12-month follow-ups, respectively. At 12-month follow-up, the median %VP in SND patients was 0.20% in the MVP group and 1.4% in the SAV+ group (P < 0.0001) and the median %VP in AVB patients was 11.8% in the MVP group and 98.1% in the SAV+ group (P < 0.001). There was no statistical difference in %VP from 1- to 12-month follow-up. A trend in the correlation between %VP and AT/AF burden was observed. Conclusion Over 12-month follow-up, the %VP was lower for MVP than SAV+ in patients with either SND or AVB. The sustainable %VP reduction has potential implications in reducing the development of heart failure and/or atrial arrhythmia morbidity.