European Heart Journal Advance Access originally published online on December 20, 2004
European Heart Journal 2005 26(7):712-722; doi:10.1093/eurheartj/ehi069
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Comparative assessment of right, left, and biventricular pacing in patients with permanent atrial fibrillation
1Department of Cardiology, Ospedali del Tigullio, Via don Bobbio, 16033 Lavagna, Italy
2Department of Cardiology, University Hospital and University of Birmingham, Birmingham, UK
3Department of Cardiology, Ospedale Civile, Cento, Italy
4Department of Cardiology, Ospedale Umberto I, Mestre, Italy
5Department of Cardiology, Royal Brompton Hospital, London, UK
6Department of Cardiology, University Hospital, Heraklion, Greece
7Department of Cardiology, Ospedale Cisanello, Pisa, Italy
8Department of Cardiology, Karolinska University Hospital, Solna, Stockholm, Sweden
9Department of Cardiology, Ospedale S Maria Nuova, Reggio Emilia, Italy
10Department of Cardiology, Ospedale Civile, Imperia, Italy
Received 3 July 2004; revised 7 October 2004; accepted 28 October 2004; online publish-ahead-of-print 20 December 2004.
* Corresponding author. Tel: +39 0185 329569; fax: +39 0185 306506. E-mail address: mbrignole{at}asl4.liguria.it
See page 637 for the editorial comment on this article (doi:10.1093/eurheartj/ehi234)
Aims Left ventricular (LV) and biventricular (BiV) pacing are potentially superior to right ventricular (RV) apical pacing in patients undergoing atrioventricular (AV) junction ablation and pacing for permanent atrial fibrillation.
Methods and results Prospective randomized, single-blind, 3-month crossover comparison between RV and LV pacing (phase 1) and between RV and BiV pacing (phase 2) performed in 56 patients (70±8 years, 34 males) affected by severely symptomatic permanent atrial fibrillation, uncontrolled ventricular rate, or heart failure. Primary endpoints were quality of life and exercise capacity. Compared with RV pacing, the Minnesota Living with Heart Failure Questionnaire (LHFQ) score improved by 2 and 10% with LV and BiV pacing, respectively, the effort dyspnoea item of the Specific Symptom Scale (SSS) changed by 0 and 2%, the Karolinska score by 6 and 14% (P<0.05 for BiV), the New York Heart Association (NYHA) class by 5 and 11% (P<0.05 for BiV), the 6-min walked distance by 12 (+4%) and 4 m (+1%), and the ejection fraction by 5 and 5% (P<0.05 for both). BiV pacing but not LV pacing was slightly better than RV pacing in the subgroup of patients with preserved systolic function and absence of native left bundle branch block. Compared with pre-ablation measures, the Minnesota LHFQ score improved by 37, 39, and 49% during RV, LV, and BiV pacing, respectively, the effort dyspnoea item of the SSS by 25, 25, and 39%, the Karolinska score by 39, 42, and 54%, the NYHA class by 21, 25, and 30%, the 6-min walking distance by 35 (12%), 47 (16%), and 51 m (19%) and the ejection fraction by 5, 10, and 10% (all differences P<0.05).
Conclusions Rhythm regularization achieved with AV-junction ablation improved quality of life and exercise capacity with all modes of pacing. LV and BiV pacing provided modest or no additional favourable effect compared with RV pacing.
Key Words: Atrial fibrillation • Heart failure • Bundle branch block • Catheter ablation • Resynchronization pacing
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