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Left ventricular-based cardiac stimulation post AV nodal ablation evaluation (the PAVE study).
Rahul N Doshi1, Emile G Daoud, Christopher Fellows
1Cardiovascular Consultants of Nevada, Las Vegas, Nevada 89074, USA. rdoshi@earthlink.net
Journal of Cardiovascular Electrophysiology
|November 24, 2005
Summary
Biventricular pacing significantly improves 6-minute walk distance and ejection fraction in atrial fibrillation patients post-AV node ablation compared to right ventricular pacing. Benefits are greater for those with heart failure symptoms or reduced ejection fraction.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Chronic right ventricular pacing can lead to cardiac dyssynchrony.
- Atrial fibrillation with rapid ventricular rates often necessitates AV node ablation.
Purpose of the Study:
- To compare chronic biventricular pacing (BVP) versus right ventricular pacing (RVP) after AV node ablation.
- To assess the impact of pacing strategy on functional capacity and cardiac function.
Main Methods:
- The PAVE trial randomized 184 patients undergoing AV node ablation to BVP (n=103) or RVP (n=81).
- Primary endpoints included changes in 6-minute walk test, quality of life, and left ventricular ejection fraction at 6 months.
Main Results:
- BVP significantly improved 6-minute walk distance (31% vs 24%) and ejection fraction (0.46 vs 0.41) compared to RVP (P=0.04 and P=0.03, respectively).
- No significant differences were observed in quality of life parameters.
- Patients with ejection fraction ≤45% or NYHA Class II/III symptoms showed greater improvements with BVP.
Conclusions:
- Biventricular pacing offers significant functional and hemodynamic benefits over right ventricular pacing in patients with atrial fibrillation undergoing AV node ablation.
- Cardiac resynchronization therapy via BVP is particularly advantageous for patients with impaired systolic function or symptomatic heart failure.