Our mission is to become a worldwide reference for education in the field for all professionals involved in the process to disseminate knowledge & skills of Acute Cardiovascular Care.
Our mission is to promote excellence in clinical diagnosis, research, technical development, and education in cardiovascular imaging in Europe.
Our mission is to promote excellence in research, practice, education and policy in cardiovascular health, primary and secondary prevention.
Our mission is to reduce the burden of cardiovascular disease in Europe through percutaneous cardiovascular interventions.
Our mission is to improve the quality of life of the population by reducing the impact of cardiac rhythm disturbances and reduce sudden cardiac death.
Our mission is to improve quality of life and longevity, through better prevention, diagnosis and treatment of heart failure, including the establishment of networks for its management, education and research.
The ESC Working Groups' goal is to stimulate and disseminate scientific knowledge in different fields of cardiology.
The ESC Councils' goal is to share knowledge among medical professionals practising in specific cardiology domains.
OUR MISSION: TO REDUCE THE BURDEN OF CARDIOVASCULAR DISEASE
Prof. Martin Stockburger,
Prof. Michael Glikson,
By Martin Stockburger, FESC (Nauen, Germany)View Discussant reportOpen the PresentationWatch the Webcast
List of AuthorsStockburger M 1, Moreno J 2, Boveda S 3, Stancak B 4, Villacastin JP 5, Lazarus A 6, Sipoetz J 7, Garcia-Seara J 8, Rolando M 9, Defaye P 101 Charité University Hospital, Experimental and Clinical Research Center (ECRC), Berlin, Germany,2 Arrhythmia Unit, Cardiology Department, Hospital Ramon y Cajal, Spain,3 Arrhythmia Unit, Pasteur Private Hospital, Toulouse, France,4 Hospital VUSCH, East slovakian Institute for Cardiac and Vascular Diseases, Kosice, Slovakia,5 San Carlos Hospital, Madrid, Spain, 6 InParys, Ambroise Paré Private Hospital, Neuilly sur Seine, France,7 Hanusch Krankenhaus, Vienna, Austria,8 Hospital Clínico Universitario, 15706 Santiago de Compostela, Spain,9 Sorin CRM SAS, Saluggia, Italy,10 Albert Michallon University Hospital, Grenoble, France,
INTRODUCTIONSeveral studies have shown that unnecessary right ventricular pacing (VP) may promote heart failure (HF) and atirial fibrillation (AF). The ANSWER study evaluated whether minimization of VP improves clinical outcome compared to standard DDD pacing in patients referred for dual chamber pacemaker implantation.METHODSANSWER is a randomized, long term follow-up, multicenter, international trial comparing SafeR, a mode designed to minimize VP by promoting intrinsic conduction, to standard DDD (AV delay left to physician’s discretion). Patients with sinus node disease (SND), intermittent AV block (AVB) or allegedly permanent AVB were enrolled. All pts were programmed in SafeR at implant. 1 month after implant, they were randomized 1:1 to SafeR or DDD. All adverse events were blindly adjudicated by a Clinical Event Committee. Reduction of VP and a composite of hospitalization for HF, AF, or cardioversion were co-primary endpoints. Secondary endpoints, presented here, included a composite of cardiac deaths and HF hospitalizations and cardiovascular hospitalizations, at 3 years. Intention-to-treat analyses were performed.RESULTS650 pts were enrolled in 43 centers in 7 countries (72.4±11.2 years, 55.2% males, 52.0% SND, 41.8% intermittent AVB and 6.2% permanent AVB) and implanted with a dual chamber pacemaker. 632 pts were randomized (314 in SafeR and 318 in DDD). Median %Vp was 11.5% in SafeR vs. 93.6% in DDD (p<0.001). The co-primary clinical composite endpoint did not significantly differ with SafeR vs. DDD (previously presented: HR=0.78; 95% CI: 0.48–1.25; p=0.30). The HF component of this endpoint tended to favour SafeR (HR=0.58; 95% CI: 0.31-1.09; p=0.09) whereas the AF component was neutral (HR=1.09; 95% CI: 0.56-2.09; p=0.80). The time to cardiac death or first HF hospitalization (figure, HR=0.49; 95%: CI 0.27–0.90; p=0.02) and the time to first cardiovascular hospitalization (HR=0.70; 95% CI: 0.49–1.00; p=0.05) were significantly prolonged in the SafeR vs. DDD group. The duration of hospitalization due to cardiovascular reason was significantly decreased in the SafeR vs. the DDD group (p=0.037, table).CONCLUSIONThe SafeR pacemaker mode significantly reduced VP compared to DDD in a broad population clinically indicated to dual chamber pacemaker due to sinus node disease or AV block. The risk in experiencing hospitalization for HF or AF or cardioversion was not significantly reduced by SafeR versus DDD. SafeR significantly increased the time to cardiac death or a first HF hospitalization, the time to first cardiovascular hospitalization and reduced the duration of cardiovascular hospitalizations.
By Michael Glikson, FESC (Ramat Gan, Israel)See Presenter abstractOpen the presentationWatch the Webcast
Clinical Trial Update Hot Line: Interventions and drug therapy
© 2017 European Society of Cardiology. All rights reserved