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Dr. Cheuk-Man Yu,
Mr Jean-Claude Daubert,
By Cheuk-Man Yu, FESC (Hong Kong, Hong Kong SAR, People's Republic of China)View Discussant report
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List of Authors: 1 Cheuk-man Yu, MD, FRCP, FACC; 1 Fang Fang, BM, PhD; 1 Xiu-xia Luo, BM; 2 Qing Zhang, BM, PhD; 3 Hussin Azlan, MD, FHRS, FACC; 3 Omar Razali, MD, FHRS, FACC1 Division of Cardiology, Department of Medicine and Therapeutics; Institute of Vascular Medicine; Institute of Innovative Medicine; Heart Education And Research Training (HEART) Center; and Li Ka Shing Institute of Health Sciences; Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong2 Department of Cardiology, West China Hospital, Sichuan University, China3 Department of Cardiology, National Heart Institute, Kuala Lumpur, Malaysia
ObjectivesWe reported the results of long-term follow-up of Pacing to Avoid Cardiac Enlargement (PACE) trial, a prospective, double-blinded, randomized, multicenter study that confirmed the superiority of biventricular (BiV) pacing to right ventricular apical (RVA) pacing in prevention of left ventricular (LV) adverse remodeling and deterioration of systolic function. MethodsPatients with bradycardia and preserved LV ejection fraction (LVEF) were randomized to receive RVA (n=88) or BiV pacing (n=89). Co-primary end-points were LV end-systolic volume (LVESV) and LVEF measured by echocardiography. ResultsThere were 149 patients who had extended followed up with a mean duration of 4.8±1.5 years. The primary end-point analyses were performed in 146 patients (74 in RVA group and 72 in BiV group). In the RVA pacing group, the LVEF decreased while the LVESV increased progressively at follow-up, but remained unchanged in the BiV pacing group. Therefore, the differences in LVEF between the RVA and BiV groups were -6.3%, -9.2% and -10.7% at 1-year, 2-year and long-term follow-up, respectively (all P<0.001). The corresponding differences in LVESV were +7.4 ml, +9.9 ml and +13.1 ml, respectively (all P<0.001). The deleterious effects of RVA pacing consistently occurred in all the pre-defined subgroups. Furthermore, patients with RVA pacing had a significantly higher prevalence of heart failure hospitalization than the BiV group (23.9% Vs 14.6%, Log-rank 2=7.55, P=0.006). ConclusionLV adverse remodeling and deterioration of systolic function continued at long-term follow-up in patients with RVA pacing, which were prevented by the use of BiV pacing. Also, heart failure hospitalization was more prevalent in the RVA pacing group.
By Jean-Claude Daubert, FESC (Rennes, France)See Presenter abstractOpen the presentationWatch the Webcast
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