| OBJECTION:To investigate the effect of biventricular (BIV) pacing and right ventricular apical (RVA) pacing on cardiac function in Chinese patients with high-degree atrioventricular block (AVB).METHODS:Consecutive patients with high-degree AVB in six hospitals from East China were enrolled from March 2009 through December 2012 in this randomized, double-blind and parallel controlled study. They were randomly allocated to BIV pacing and RVA pacing group with or without LV lead on after one-week Cardiac Resynchronization Therapy (CRT). Cardiac function were assessed at 6 months and 12 months, including heart failure (HF) hospitalizations, atrial fibrillation(AF) burden, New York Heart Association (NYHA) functional classification, Six Minute Walking Distance (6MWD), Minnesota Living with Heart Failure (MLHF) score, left ventricular ejection fraction(LVEF), left ventricular end-diastolic volumes/diameters (LVEDV/LVEDD) and other echocardiography parameters, as well as NT-pro BNP.RESULTS:Of 118 enrolled patients,114 ones were successfully implanted with CRT. Cardiac function improved after one-week BIV pacing, including percentage of patients with NYHA Ⅲ (25.44%vs9.65%), MLHF score(17.10±13.60vs26.91±21.62),6MWD(315.36±121.78vs291.83±102.87m) and NT-proBNP[157.00(70.00,639.00)vs444.70(144.00,1546.00)ng/L], as compared with pre-CRT(P<0.05). Then all these subjects were randomly assigned to BIV group (CRT-on) and RVA group (CRT-off).Each group had 57 patients. The characteristic of the two group matched at baseline.During 12 months follow-up, HF hospitalizations and AF burden showed no difference between two groups(P>0.05). RVA group had higher concentrations of NT-proBNP at 12 months than that at 1week [349.50(191.75,884.25) vs127.00 (70.25,336.70)ng/L], and the concentrations’ changes in two groups differed at 6 months [3.3(-13.4,37.2) vs 60(-18.1,248)].(P=0.045) In BIV group,6MWD extended from (314.79±142.69)m to (332.72±117.52) at 6 months, LVEF increased from (60.66±7.86)% (at 1week) to(56.63±10.73)% (at 6 months), both of LVEDV and LVEDD at 12 months decreased comparing with those at lweek(116.23±39.54 vs 131.38±49.62ml and 50.19±5.64 vs 52.48±6.83mm); In RVA group,6MWD increased from (310.20±105.08)m at lweek to (342.37±109.91)m at 6 months. Compared with RVA group, BIV group had higher LVEF improvement at 6 months (BIV3.18±6.79% vs RVA-1.41±6.44%, P<0.05) and a bigger shrink in △LVEDV and ALVEDD at 12 months(-16.68±24.30vs9.09±29.30ml and-1.75±5.79 vs 2.36±9.32mm). (P<0.05)CONCLUSION:Cardiac resynchronization therapy could improve the cardiac function in patients with high-degree AVB. Compared with RVA pacing, one-year BIV pacing improved cardiac function, reduced LV ventricle more significantly and prevented the deterioration of cardiac function by RVA pacing. |
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