Efficacy, Safety, and Performance of Isolated Left vs. Right Ventricular Pacing in Patients with Bradyarrhythmias: A Randomized Controlled Trial

dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorCREVELARI, Elizabeth Sartori
dc.contributor.authorSILVA, Katia Regina da
dc.contributor.authorALBERTINI, Caio Marcos de Moraes
dc.contributor.authorVIEIRA, Marcelo Luiz Campos
dc.contributor.authorMARTINELLI FILHO, Martino
dc.contributor.authorCOSTA, Roberto
dc.date.accessioned2019-05-30T13:29:48Z
dc.date.available2019-05-30T13:29:48Z
dc.date.issued2019
dc.description.abstractBackground: Considering the potential deleterious effects of right ventricular (RV) pacing, the hypothesis of this study is that isolated left ventricular (LV) pacing through the coronary sinus is safe and may provide better clinical and echocardiographic benefits to patients with bradyarrhythmias and normal ventricular function requiring heart rate correction alone. Objective: To assess the safety, efficacy, and effects of LV pacing using an active-fixation coronary sinus lead in comparison with RV pacing, in patients eligible for conventional pacemaker (PM) implantation. Methods: Randomized, controlled, and single-blinded clinical trial in adult patients submitted to PM implantation due to bradyarrhythmias and systolic ventricular function >= 0.40. Randomization (RV vs. LV) occurred before PM implantation. The main results of the study were procedural success, safety, and efficacy. Secondary results were clinical and echocardiographic changes. Chi-squared test, Fisher's exact test and Student's t-test were used, considering a significance level of 5%. Results: From June 2012 to January 2014, 91 patients were included, 36 in the RV Group and 55 in the LV Group. Baseline characteristics of patients in both groups were similar. PM implantation was performed successfully and without any complications in all patients in the RV group. Of the 55 patients initially allocated into the LV group, active-fixation coronary sinus lead implantation was not possible in 20 (36.4%) patients. The most frequent complication was phrenic nerve stimulation, detected in 9 (25.7%) patients in the LV group. During the follow-up period, there were no hospitalizations due to heart failure. Reductions of more than 10% in left ventricular ejection fraction were observed in 23.5% of patients in the RV group and 20.6% of those in the LV group (p = 0.767). Tissue Doppler analysis showed that 91.2% of subjects in the RV group and 68.8% of those in the LV group had interventricular dyssynchrony (p = 0.022). Conclusion: The procedural success rate of LV implant was low, and the safety of the procedure was influenced mainly by the high rate of phrenic nerve stimulation in the postoperative period.eng
dc.description.indexMEDLINEeng
dc.description.sponsorshipMedtronic
dc.identifier.citationARQUIVOS BRASILEIROS DE CARDIOLOGIA, v.112, n.4, p.410-420, 2019
dc.identifier.doi10.5935/abc.20180275
dc.identifier.issn0066-782X
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/31675
dc.language.isoeng
dc.publisherARQUIVOS BRASILEIROS CARDIOLOGIAeng
dc.relation.ispartofArquivos Brasileiros de Cardiologia
dc.rightsopenAccesseng
dc.rights.holderCopyright ARQUIVOS BRASILEIROS CARDIOLOGIAeng
dc.subjectCardiac Pacingeng
dc.subjectArtificialeng
dc.subjectBradycardiaeng
dc.subjectArrhythmiaseng
dc.subjectCardiaceng
dc.subjectPacemakereng
dc.subjectArtificialeng
dc.subjectVentricular remodelingeng
dc.subject.othergrade atrioventricular-blockeng
dc.subject.otherheart-failureeng
dc.subject.othercardiac resynchronizationeng
dc.subject.otherstimulationeng
dc.subject.othertherapyeng
dc.subject.otherdyssynchronyeng
dc.subject.otherguidelineseng
dc.subject.otherrhythmeng
dc.subject.otherleadeng
dc.subject.wosCardiac & Cardiovascular Systemseng
dc.titleEfficacy, Safety, and Performance of Isolated Left vs. Right Ventricular Pacing in Patients with Bradyarrhythmias: A Randomized Controlled Trialeng
dc.typearticleeng
dc.type.categoryoriginal articleeng
dc.type.versionpublishedVersioneng
dspace.entity.typePublication
hcfmusp.citation.scopus4
hcfmusp.contributor.author-fmusphcELIZABETH SARTORI CREVELARI
hcfmusp.contributor.author-fmusphcKATIA REGINA DA SILVA
hcfmusp.contributor.author-fmusphcCAIO MARCOS DE MORAES ALBERTINI
hcfmusp.contributor.author-fmusphcMARCELO LUIZ CAMPOS VIEIRA
hcfmusp.contributor.author-fmusphcMARTINO MARTINELLI FILHO
hcfmusp.contributor.author-fmusphcROBERTO COSTA
hcfmusp.description.beginpage410
hcfmusp.description.endpage420
hcfmusp.description.issue4
hcfmusp.description.volume112
hcfmusp.origemWOS
hcfmusp.origem.pubmed30994720
hcfmusp.origem.scieloSCIELO:S0066-782X2019000400410
hcfmusp.origem.scopus2-s2.0-85064986646
hcfmusp.origem.wosWOS:000464635100010
hcfmusp.publisher.cityRIO DE JANEIROeng
hcfmusp.publisher.countryBRAZILeng
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hcfmusp.scopus.lastupdate2024-06-14
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