In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.
Did you know that your browser is out of date? To get the best experience using our website we recommend that you upgrade to a newer version. Learn more.

We use cookies to optimise the design of this website and make continuous improvement. By continuing your visit, you consent to the use of cookies. Learn more

Long-term Follow-up Result of the Pacing to Avoid Cardiac Enlargement (PACE) Trial

ESC Congress 2014 - Hot Line report




By Cheuk-Man Yu, FESC (Hong Kong, Hong Kong SAR, People's Republic of China)
View Discussant report

Open the Presentation
Watch the Webcast

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, FACC
1 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 Kong
2 Department of Cardiology, West China Hospital, Sichuan University, China
3 Department of Cardiology, National Heart Institute, Kuala Lumpur, Malaysia


We 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.
Patients 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. 
There 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).
LV 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 abstract
Open the presentation
Watch the Webcast


CM Yu et al (Hong-Kong) presented the long-term results of the PACE trial, a randomised study comparing biventricular (BiV) pacing and standard right ventricular (RV) pacing in patients with a conventional pacemaker indication and a preserved ejection fraction. During a mean f/u time of 5 years, a continuous decline in LV systolic function (LESV and LVEF) was observed in the RV arm when no significant changes occured in BiV, thus indicating that BiV may prevent pacing-induced ventricular remodelling in this population. However, the differences were modest in size and there was no evidence of functional and outcome benefit associated with BiV except a lower proportion of HF hospitalisations after 3-years.
These data are of real interest but are not strong enough to recommend BiV in all pacemaker patients. Further evidence on the real clinical benefit and risk to benefit ratio is needed keeping in mind that the pacemaker population is an elderly population.




Clinical Trial Update Hot Line: Interventions and drug therapy

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.