PMID- 16636167
OWN - NLM
STAT- MEDLINE
DCOM- 20060512
LR  - 20071115
IS  - 1524-4539 (Electronic)
IS  - 0009-7322 (Linking)
VI  - 113
IP  - 17
DP  - 2006 May 2
TI  - Heart failure during cardiac pacing.
PG  - 2082-8
AB  - BACKGROUND: Right ventricular apical (RVA) pacing creates abnormal left 
      ventricular contraction, hypertrophy, and reduced pump function. The adverse 
      effects of ventricular desynchronization may explain the association of RVA 
      pacing with an increased risk of heart failure hospitalization (HFH) in clinical 
      trials. METHODS AND RESULTS: Baseline and postimplantation variables were used to 
      predict HFH in the Mode Selection Trial, a 2010-patient, 6-year trial of 
      dual-chamber (DDDR) versus ventricular (VVIR) pacing in sinus node dysfunction. A 
      Cox model showed that New York Heart Association (NYHA) class at baseline and 
      follow-up predicted HFH (hazard ratio [HR], 3.99; 95% confidence interval [CI], 
      2.74-5.79 for NYHA class III/IV and HR, 2.17; 95% CI, 1.54-3.04 for NYHA class II 
      versus class I); other predictors were heart failure (HR, 2.30; 95% CI, 
      1.70-3.11), atrioventricular (AV) block (HR, 1.48; 95% CI, 1.11-1.97), and 
      myocardial infarction (MI)(HR, 1.37; 95% CI, 1.00-1.86). Postimplantation 
      predictors were VVIR cumulative percent ventricular pacing (Cum%VP) >80 (HR, 
      3.58; 95% CI, 1.72-7.45), DDDR Cum%VP >40 or VVIR Cum%VP < or =80 (HR, 1.81; 95% 
      CI, 0.94-3.50) versus DDDR Cum%VP < or =40; whether QRS duration (QRSd) was paced 
      or spontaneous (HR, 2.21; 95% CI, 1.39-3.54; spontaneous versus paced); and drugs 
      for atrial fibrillation (HR, 1.60; 95% CI, 1.19-2.15). Low baseline ejection 
      fraction (EF) and postimplantation RVA-paced or spontaneous QRSd predicted HFH; 
      the increased risk with QRSd was steeper for normal versus low EF (HR, 1.18; 95% 
      CI, 1.11-1.27; versus HR, 1.08; 95% CI, 1.01-1.15; for a 10-ms increase); at a 
      QRSd of approximately 200 ms, normal- and low-EF patients had equivalent risk. 
      HFH risk nearly doubled when VVIR Cum%VP was < or =80 or DDDR Cum%VP was >40 
      versus DDDR Cum%VP < or =40 and was additive with other risk factors. 
      CONCLUSIONS: Differences in HFH risk can be explained by interactions between 
      substrate (atrial fibrillation, AV conduction, heart failure, MI, EF) and pacing 
      promoters (ventricular desynchronization-paced QRSd and Cum%VP, and AV 
      desynchronization-pacing mode). Management of RVA pacing is important for 
      reducing the risk of HFH, particularly among patients with low EF and heart 
      failure.
FAU - Sweeney, Michael O
AU  - Sweeney MO
AD  - Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 
      mosweeney@partners.org
FAU - Hellkamp, Anne S
AU  - Hellkamp AS
LA  - eng
GR  - U01 HL 49804/HL/NHLBI NIH HHS/United States
GR  - U01 HL 53973/HL/NHLBI NIH HHS/United States
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, N.I.H., Extramural
DEP - 20060424
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
SB  - IM
MH  - Atrioventricular Node/physiopathology
MH  - Cardiac Pacing, Artificial/*adverse effects/methods
MH  - Electrocardiography
MH  - Heart Failure/*etiology
MH  - Humans
MH  - Prospective Studies
MH  - Stroke Volume
EDAT- 2006/04/26 09:00
MHDA- 2006/05/13 09:00
CRDT- 2006/04/26 09:00
PHST- 2006/04/26 09:00 [pubmed]
PHST- 2006/05/13 09:00 [medline]
PHST- 2006/04/26 09:00 [entrez]
AID - CIRCULATIONAHA.105.608356 [pii]
AID - 10.1161/CIRCULATIONAHA.105.608356 [doi]
PST - ppublish
SO  - Circulation. 2006 May 2;113(17):2082-8. doi: 10.1161/CIRCULATIONAHA.105.608356. 
      Epub 2006 Apr 24.