PURPOSE: The EVOCAV(DS) trial aimed to quantify the paradoxal atrioventricular (AV) conduction time lengthening in sinus node (SD) patients (pts) paced in AAIR-based pacing mode. METHODS: SD pts, implanted with dual-chamber pacemaker programmed in AAIR-based pacing mode, were randomized in two arms for a 1-month period: the low atrial pacing (LAP; basic rate at 60 bpm, dual sensor with minimal slope) and the high atrial pacing (HAP; basic rate at 70 bpm, dual sensor with optimized slope, overdrive pacing) arm. At 1 month, crossover was performed for an additional 1-month period. AV conduction time, AV block occurrence and AV conduction time adaptation during exercise were ascertained from device memories at each follow-up. RESULTS:Seventy-nine pts participated to the analysis (75 ± 8 years; 32 male; PR = 184 ± 38 ms; bundle branch block n = 12; AF history n = 36; antiarrhythmic treatment n = 53; beta-blockers n = 27; class III/Ic n = 18; both n = 8). The mean AV conduction time was significantly greater during the HAP (275 ± 51 ms) vs. LAP (263 ± 49 ms) period (p < 0.0001). Class III/Ic drugs were the only predictors of this abnormal behaviour. Degree II/III AV blocks occurred in 49 % of pts in the HAP vs. 19 % in the LAP period (p < 0.0001). Fifty-two patients (66 %) presented a lengthening of AV conduction time during exercise. CONCLUSION:AAIR-based pacing in SD pts may induce a significant lengthening of pts' AV conduction time, including frequent abnormal adaptation of AV conduction time during exercise.
RCT Entities:
PURPOSE: The EVOCAV(DS) trial aimed to quantify the paradoxal atrioventricular (AV) conduction time lengthening in sinus node (SD) patients (pts) paced in AAIR-based pacing mode. METHODS: SD pts, implanted with dual-chamber pacemaker programmed in AAIR-based pacing mode, were randomized in two arms for a 1-month period: the low atrial pacing (LAP; basic rate at 60 bpm, dual sensor with minimal slope) and the high atrial pacing (HAP; basic rate at 70 bpm, dual sensor with optimized slope, overdrive pacing) arm. At 1 month, crossover was performed for an additional 1-month period. AV conduction time, AV block occurrence and AV conduction time adaptation during exercise were ascertained from device memories at each follow-up. RESULTS: Seventy-nine pts participated to the analysis (75 ± 8 years; 32 male; PR = 184 ± 38 ms; bundle branch block n = 12; AF history n = 36; antiarrhythmic treatment n = 53; beta-blockers n = 27; class III/Ic n = 18; both n = 8). The mean AV conduction time was significantly greater during the HAP (275 ± 51 ms) vs. LAP (263 ± 49 ms) period (p < 0.0001). Class III/Ic drugs were the only predictors of this abnormal behaviour. Degree II/III AV blocks occurred in 49 % of pts in the HAP vs. 19 % in the LAP period (p < 0.0001). Fifty-two patients (66 %) presented a lengthening of AV conduction time during exercise. CONCLUSION: AAIR-based pacing in SD pts may induce a significant lengthening of pts' AV conduction time, including frequent abnormal adaptation of AV conduction time during exercise.
Authors: Panos E Vardas; Angelo Auricchio; Jean-Jacques Blanc; Jean-Claude Daubert; Helmut Drexler; Hugo Ector; Maurizio Gasparini; Cecilia Linde; Francisco Bello Morgado; Ali Oto; Richard Sutton; Maria Trusz-Gluza Journal: Eur Heart J Date: 2007-08-28 Impact factor: 29.983
Authors: H R Andersen; J C Nielsen; P E Thomsen; L Thuesen; T Vesterlund; A K Pedersen; P T Mortensen Journal: Circulation Date: 1998-09-29 Impact factor: 29.690
Authors: P E Vardas; E N Simantirakis; F I Parthenakis; S I Chrysostomakis; E I Skalidis; E G Zuridakis Journal: Pacing Clin Electrophysiol Date: 1997-07 Impact factor: 1.976
Authors: D Barbieri; G F Percoco; T Toselli; G Guardigli; L Ansani; G E Antonioli Journal: Pacing Clin Electrophysiol Date: 1990-12 Impact factor: 1.976
Authors: T Ishikawa; K Kimura; N Miyazaki; O Tochikubo; T Usui; M Kashiwagi; M Ishii Journal: Pacing Clin Electrophysiol Date: 1992-11 Impact factor: 1.976