VVI pacing with normal QRS duration and ventricular function: MOST trial findings relevant to leadless pacemakers.
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2020-12
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Abstract
Background
Leadless pacemakers (LPs) provide ventricular pacing without the risks associated with transvenous leads and device pockets. LPs are appealing for patients who need pacing, but do not need defibrillator or cardiac resynchronization therapy. Most implanted LPs provide right ventricular pacing without atrioventricular synchrony (VVIR mode). The Mode Selection Trial in Sinus Node Dysfunction (MOST) showed similar outcomes in patients randomized to dual-chamber (DDDR) versus ventricular pacing (VVIR). We compared outcomes by pacing mode in LP-eligible patients from MOST.Methods
Patients enrolled in the MOST study with an left ventricular ejection fraction (LVEF) >35%, QRS duration (QRSd) <120 ms and no history of ventricular arrhythmias or prior implantable cardioverter defibrillators were included (LP-eligible population). Cox proportional hazards models were used to test the association between pacing mode and death, stroke or heart failure (HF) hospitalization and atrial fibrillation (AF).Results
Of the 2010 patients enrolled in MOST, 1284 patients (64%) met inclusion criteria. Baseline characteristics were well balanced across included patients randomized to DDDR (N = 630) and VVIR (N = 654). Over 4 years of follow-up, there was no association between pacing mode and death, stroke or HF hospitalization (VVIR HR 1.28 [0.92-1.75]). VVIR pacing was associated with higher risk of AF (HR 1.32 [1.08-1.61], P = .007), particularly in patients with no history of AF (HR 2.38 [1.52-3.85], P < .001).Conclusion
In patients without reduced LVEF or prolonged QRSd who would be eligible for LP, DDDR, and VVIR pacing demonstrated similar rates of death, stroke or HF hospitalization; however, VVIR pacing significantly increased the risk of AF development.Type
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Loring, Zak, Rebecca North, Anne S Hellkamp, Brett D Atwater, Camille G Frazier-Mills, Kevin P Jackson, Sean D Pokorney, Gervasio A Lamas, et al. (2020). VVI pacing with normal QRS duration and ventricular function: MOST trial findings relevant to leadless pacemakers. Pacing and clinical electrophysiology : PACE, 43(12). pp. 1461–1466. 10.1111/pace.14100 Retrieved from https://hdl.handle.net/10161/30479.
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Scholars@Duke
Zak Loring
I am a cardiac electrophysiologist specializing in the treatment of heart rhythm disorders and management of cardiac implantable electronic devices (CIEDs). My research utilizes signal processing of electrocardiographic data and novel analytic techniques to better phenotype patients and identify those for whom interventional electrophysiology procedures may be most beneficial. This includes predicting which patients with left bundle branch block may benefit from early cardiac resynchronization therapy or conduction system pacing. I also analyze population level data to identify patients at high risk for adverse sequelae of rhythm disorders who may benefit from early intervention.
Rebecca North
Rebecca North, PhD
Dr. North is a collaborative biostatistician who lets clinical application drive methodological innovation. This has been true since graduate school at NC State University, where her dissertation focused on variable selection methods for functional data for the purpose of identifying a sparse set of electromyogram signals that would accurately predict the velocity of a prosthetic arm. Also while in graduate school, Dr. North was supported by a T32 Traineeship, the National Heart, Lung, and Blood Institute Integrated Biostatistical Training Program for Cardiovascular Disease Research, through which she gained clinical research experience at the Duke Clinical Research Institute with particular focus on atrial fibrillation research.
Since joining the Duke Aging Center, Dr. North has gained statistical experience in latent class analysis, mediation analysis, and meta-analysis, to add to her knowledge of functional data analysis, variable selection techniques, random forests and decision trees, survival analysis, longitudinal data analysis, and other classical frequentist statistical methods. Her clinical areas of interest include circadian rhythm research, cardiovascular research (particularly atrial fibrillation), and Veteran health.
Camille Genise Frazier
Kevin Patrick Jackson
Research interests include:
- optimization of device timing for Cardiac Resynchronzation Therapy (CRT)
- novel cardiac imaging technologies for CRT
- catheter ablation versus anti-arrhythmic drug for treatment of atrial fibrillation.
Sean Pokorney
Unless otherwise indicated, scholarly articles published by Duke faculty members are made available here with a CC-BY-NC (Creative Commons Attribution Non-Commercial) license, as enabled by the Duke Open Access Policy. If you wish to use the materials in ways not already permitted under CC-BY-NC, please consult the copyright owner. Other materials are made available here through the author’s grant of a non-exclusive license to make their work openly accessible.