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

Haran Burri, Hajo Müller, Richard Kobza, Christian Sticherling, Peter Ammann, Heiko Zerlik, Carine Stettler, Catherine Klersy, Frits Prinzen & Angelo Auricchio

abstract

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).
   
citation Burri H, Müller H, Kobza R, Sticherling C, Ammann P, Zerlik H, Stettler C, Klersy C, Prinzen F, 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)
date of publishing 28-10-2017
journal title Indian Pacing Electrophysiol J (17/6)
ISSN print 0972-6292
pages 171-175
PubMed 29110936
DOI 10.1016/j.ipej.2017.10.004