VVI pacing with normal QRS duration and ventricular function: MOST trial findings relevant to leadless pacemakers.
| dc.contributor.author | Loring, Zak | |
| dc.contributor.author | North, Rebecca | |
| dc.contributor.author | Hellkamp, Anne S | |
| dc.contributor.author | Atwater, Brett D | |
| dc.contributor.author | Frazier-Mills, Camille G | |
| dc.contributor.author | Jackson, Kevin P | |
| dc.contributor.author | Pokorney, Sean D | |
| dc.contributor.author | Lamas, Gervasio A | |
| dc.contributor.author | Piccini, Jonathan P | |
| dc.date.accessioned | 2024-04-04T21:57:56Z | |
| dc.date.available | 2024-04-04T21:57:56Z | |
| dc.date.issued | 2020-12 | |
| dc.description.abstract | BackgroundLeadless 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.MethodsPatients 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).ResultsOf 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).ConclusionIn 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. | |
| dc.identifier.issn | 0147-8389 | |
| dc.identifier.issn | 1540-8159 | |
| dc.identifier.uri | ||
| dc.language | eng | |
| dc.publisher | Wiley | |
| dc.relation.ispartof | Pacing and clinical electrophysiology : PACE | |
| dc.relation.isversionof | 10.1111/pace.14100 | |
| dc.rights.uri | ||
| dc.subject | Humans | |
| dc.subject | Atrial Fibrillation | |
| dc.subject | Sick Sinus Syndrome | |
| dc.subject | Cardiac Pacing, Artificial | |
| dc.subject | Equipment Design | |
| dc.subject | Pacemaker, Artificial | |
| dc.subject | Aged | |
| dc.subject | Aged, 80 and over | |
| dc.subject | United States | |
| dc.subject | Female | |
| dc.subject | Male | |
| dc.title | VVI pacing with normal QRS duration and ventricular function: MOST trial findings relevant to leadless pacemakers. | |
| dc.type | Journal article | |
| duke.contributor.orcid | Loring, Zak|0000-0002-4613-582X | |
| duke.contributor.orcid | North, Rebecca|0000-0002-2877-3801 | |
| duke.contributor.orcid | Pokorney, Sean D|0000-0002-4345-0816 | |
| duke.contributor.orcid | Piccini, Jonathan P|0000-0003-0772-2404 | |
| pubs.begin-page | 1461 | |
| pubs.end-page | 1466 | |
| pubs.issue | 12 | |
| pubs.organisational-group | Duke | |
| pubs.organisational-group | School of Medicine | |
| pubs.organisational-group | Faculty | |
| pubs.organisational-group | Staff | |
| pubs.organisational-group | Basic Science Departments | |
| pubs.organisational-group | Clinical Science Departments | |
| pubs.organisational-group | Institutes and Centers | |
| pubs.organisational-group | Medicine | |
| pubs.organisational-group | Medicine, Cardiology | |
| pubs.organisational-group | Duke Clinical Research Institute | |
| pubs.organisational-group | Center for the Study of Aging and Human Development | |
| pubs.organisational-group | Population Health Sciences | |
| pubs.publication-status | Published | |
| pubs.volume | 43 |
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