RIght VErsus Left Apical transvenous pacing for bradycardia: Results of the RIVELA randomized study
Haran Burri1, Hajo Müller1, Richard Kobza2
1University Hospital of Geneva, Switzerland.
Insights
Left ventricular apical pacing is comparable to conventional right ventricular apical pacing for cardiac function over one year. This study compared pacing strategies in patients with preserved left ventricular systolic function.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Pacing
Background:
- Conventional right ventricular apical (RVA) pacing can lead to dyssynchrony and impaired cardiac function.
- Alternative pacing sites are being investigated to optimize ventricular function in patients requiring bradycardia pacing.
Purpose of the Study:
- To compare cardiac function between RVA and left ventricular apical (LVA) pacing in patients with preserved left ventricular systolic function.
- To evaluate the safety and efficacy of LVA pacing over a 1-year follow-up period.
Main Methods:
- Prospective, multicenter randomized trial comparing RVA pacing with LVA pacing via a coronary sinus lead.
- 3D-echocardiography was used for follow-up at 6 and 12 months to assess cardiac function.
Main Results:
- No significant difference in left ventricular ejection fraction (LVEF) at 1 year between RVA (60.4±7.1%) and LVA (62.1±7.2%) groups.
- No differences observed in left ventricular dimensions, diastolic function, right ventricular systolic function, or valvular insufficiency.
- Higher capture thresholds and two instances of lead dislodgement were noted in the LVA group.
Conclusions:
- Left ventricular apical pacing demonstrates comparable ventricular function to RVA pacing up to 1 year.
- LVA pacing is a viable option for selected patients, such as those with a tricuspid valve prosthesis.
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).
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