Publication

RIght VErsus Left Apical transvenous pacing for bradycardia: Results of the RIVELA randomized study

Journal Paper/Review - Oct 28, 2017

Units
PubMed
Doi

Citation
Burri H, Prinzen F, Klersy C, Stettler C, Zerlik H, Ammann P, Sticherling C, Kobza R, Müller H, Auricchio A. RIght VErsus Left Apical transvenous pacing for bradycardia: Results of the RIVELA randomized study. Indian Pacing Electrophysiol J 2017; 17:171-175.
Type
Journal Paper/Review (English)
Journal
Indian Pacing Electrophysiol J 2017; 17
Publication Date
Oct 28, 2017
Issn Print
0972-6292
Pages
171-175
Brief description/objective

AIMS
To compare cardiac function when pacing from the right or left ventricular apex in patients with preserved left ventricular systolic function, at 1-year follow-up.

METHODS
Prospective, multicentre centre randomizing conventional right ventricular apical (RVA) versus left ventricular apical (LVA) pacing using a coronary sinus lead in patients requiring ventricular pacing for bradycardia. Follow-up was performed using 3D-echocardiography at 6 and 12 months.

RESULTS
A total of 36 patients (age 75.4 ± 8.7 years, 21 males) were enrolled (17 patients in the RVA group and 19 patients in the LVA group). A right ventricular lead was implanted in 8 patients in the LVA group, mainly because of high capture thresholds. There were no differences in the primary endpoint of LVEF at 1 year (60.4 ± 7.1% vs 62.1 ± 7.2% for the RVA and LVA groups respectively, P = 0.26) nor in any of the secondary endpoints (left ventricular dimensions, left ventricular diastolic function, right ventricular systolic function and tricuspid/mitral insufficiency). LVEF did not change significantly over follow-up in either group. Capture thresholds were significantly higher in the LVA group, and two patients had unexpected loss of capture of the coronary sinus lead during follow-up.

CONCLUSIONS
Left univentricular pacing seems to be comparable to conventional RVA pacing in terms of ventricular function at up to 1 year follow-up, and is an option to consider in selected patients (e.g. those with a tricuspid valve prosthesis).