PMID- 16627409
OWN - NLM
STAT- MEDLINE
DCOM- 20060623
LR  - 20071115
IS  - 1099-5129 (Print)
IS  - 1099-5129 (Linking)
VI  - 8
IP  - 1
DP  - 2006 Jan
TI  - Upgrade to biventricular pacing in patients with conventional pacemakers and 
      heart failure: a double-blind, randomized crossover study.
PG  - 51-5
AB  - AIMS: To investigate whether patients with previously implanted conventional 
      pacemakers and severe heart failure benefit from an upgrade to a biventricular 
      system. METHODS AND RESULTS: Study inclusion criteria were New York Heart 
      Association (NYHA) classes III and IV, dominant paced rhythm, and no left bundle 
      branch block in the pre-pacing ECG. Ten patients with pacemakers (four VVIR due 
      to slow atrial fibrillation and six DDDR, of which four were due to high-degree 
      atrioventricular block and two to sinus node disease) were upgraded to a 
      biventricular pacing (BVP) system. The median duration of pacing before the 
      upgrade was 5.7 years. Assessments of 6-min walk test, symptom score, brain 
      natriuretic peptide (pro-BNP), and echocardiography were made pre-operatively. 
      After a run-in period of 1 month in BVP following the upgrade, the patients were 
      randomized to a 2-month period in either BVP or right ventricular pacing (RVP), 
      followed by 2 months in the other mode, in a double-blind crossover fashion. 
      After each period, the pre-operative measurements were repeated. After study 
      completion, patients were asked to select their preferred period. The median 
      6-min walking distance was significantly longer in BVP (400 m) vs. RVP (315 m), P 
      = 0.02. The symptom score was also significantly better in BVP (P = 0.005). 
      Median pro-BNP was significantly lower in BVP than in RVP, 3,030 vs. 5,064 ng/L 
      (P = 0.005). Six patients demanded an early crossover in RVP but none in BVP (P = 
      0.015), and all patients except one expressed a preference for BVP. However, echo 
      parameters did not show any significant differences between BVP and RVP. 
      CONCLUSION: Pacemaker patients with heart failure and dominant paced heart rhythm 
      benefit substantially from an upgrade to BVP, in terms of physical performance 
      and symptoms. The upgrade resulted in significantly improved cardiac function as 
      reflected by reduced levels of pro-BNP.
FAU - Hoijer, Carl J
AU  - Hoijer CJ
AD  - Department of Cardiology, Heart and Lung Division, Lund University Hospital, 
      S-221 85 Lund, Sweden. carl-johan.hoijer@skane.se
FAU - Meurling, Carl
AU  - Meurling C
FAU - Brandt, Johan
AU  - Brandt J
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PL  - England
TA  - Europace
JT  - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal 
      of the working groups on cardiac pacing, arrhythmias, and cardiac cellular 
      electrophysiology of the European Society of Cardiology
JID - 100883649
RN  - 114471-18-0 (Natriuretic Peptide, Brain)
SB  - IM
MH  - Aged
MH  - Cardiac Pacing, Artificial/*methods
MH  - Cross-Over Studies
MH  - Double-Blind Method
MH  - Echocardiography
MH  - Electrocardiography
MH  - Exercise Test
MH  - Female
MH  - Heart Failure/physiopathology/*therapy
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Natriuretic Peptide, Brain/blood
MH  - Quality of Life
MH  - Statistics, Nonparametric
MH  - Treatment Outcome
EDAT- 2006/04/22 09:00
MHDA- 2006/06/24 09:00
CRDT- 2006/04/22 09:00
PHST- 2006/04/22 09:00 [pubmed]
PHST- 2006/06/24 09:00 [medline]
PHST- 2006/04/22 09:00 [entrez]
AID - 8/1/51 [pii]
AID - 10.1093/europace/euj014 [doi]
PST - ppublish
SO  - Europace. 2006 Jan;8(1):51-5. doi: 10.1093/europace/euj014.