Giuseppe Boriani1, Paolo Pieragnoli2, Giovanni Luca Botto3, Helmut Puererfellner4, Lluis Mont5, Matteo Ziacchi6, Antonis S Manolis7, Michele Gulizia8, Raymond Tukkie9, Maurizio Landolina10, Giuseppe Ricciardi2, Manuele Cicconelli11, Andrea Grammatico11, Mauro Biffi6. 1. Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena University Hospital, via Giuseppe Campi, 287, Modena, Italy. 2. Institute of Internal Medicine and Cardiology, University Hospital of Florence, Florence, Italy. 3. Cardiac Electrophysiology, ASST Rhodense, Rho AND Garbagnate Hospitals, Milan, Italy. 4. Ordensklinikum Linz Elisabethinen, Linz, Austria. 5. Department of Cardiology, Hospital Clinic, University of Barcelona, Spain. 6. Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S.Orsola-Malpighi University Hospital, Bologna, Italy. 7. Third Department of Cardiology, Athens University School of Medicine, Athens, Greece. 8. Cardiology Department, Garibaldi Nesima Hospital, Catania, Italy. 9. Department of Cardiology, Kennemer Gasthuis, Haarlem, The Netherlands. 10. Institute of Cardiology, Maggiore Hospital, Crema, Italy. 11. Study & Scientific Solutions, Medtronic Core Clinical Solutions, Rome, Italy.
Abstract
AIMS: Per standard of care, dual-chamber pacemakers are programmed in DDDR mode with fixed atrioventricular (AV) delay or with long AV delay to minimize ventricular pacing. We aimed to evaluate whether the PR interval may be a specific criterion of choice between standard DDDR, to preserve AV synchrony in long PR patients, and managed ventricular pacing (MVP), to avoid ventricular desynchronization imposed by right ventricle apical pacing, in short PR patients. METHODS AND RESULTS: In the MINERVA trial, 1166 patients were randomized toControl DDDR, MVP, or atrial anti-tachycardia pacing plus MVP (DDDRP + MVP). We evaluated the interaction of PR interval with pacing mode by comparing the risk of atrial fibrillation (AF) longer than 7 consecutive days as a function of PR interval. Out of 906 patients with available data, the median PR interval was 180 ms. The PR interval was found to significantly (P = 0.012) interact with pacing mode for AF incidence: the risk of AF > 7 days was lower [hazard ratio (HR) 0.58, 95% confidence interval (95% CI) 0.34-0.99; P = 0.047] in patients with short PR (shorter than median PR) if programmed in MVP mode compared with DDDR mode and it was lower (HR 0.65, 95% CI 0.43-0.99; P = 0.049) in patients with long PR (equal to or longer than median PR) if programmed in DDDR mode compared with MVP. CONCLUSION: Our data show that PR interval may be used as a selection criterion to identify the optimal physiological pacing mode. Persistent AF incidence was lower in short PR patients treated by right ventricular pacing minimization and in long PR patients treated by standard dual-chamber pacing. Published on behalf of the European Society of Cardiology. All rights reserved.
RCT Entities:
AIMS: Per standard of care, dual-chamber pacemakers are programmed in DDDR mode with fixed atrioventricular (AV) delay or with long AV delay to minimize ventricular pacing. We aimed to evaluate whether the PR interval may be a specific criterion of choice between standard DDDR, to preserve AV synchrony in long PR patients, and managed ventricular pacing (MVP), to avoid ventricular desynchronization imposed by right ventricle apical pacing, in short PR patients. METHODS AND RESULTS: In the MINERVA trial, 1166 patients were randomized to Control DDDR, MVP, or atrial anti-tachycardia pacing plus MVP (DDDRP + MVP). We evaluated the interaction of PR interval with pacing mode by comparing the risk of atrial fibrillation (AF) longer than 7 consecutive days as a function of PR interval. Out of 906 patients with available data, the median PR interval was 180 ms. The PR interval was found to significantly (P = 0.012) interact with pacing mode for AF incidence: the risk of AF > 7 days was lower [hazard ratio (HR) 0.58, 95% confidence interval (95% CI) 0.34-0.99; P = 0.047] in patients with short PR (shorter than median PR) if programmed in MVP mode compared with DDDR mode and it was lower (HR 0.65, 95% CI 0.43-0.99; P = 0.049) in patients with long PR (equal to or longer than median PR) if programmed in DDDR mode compared with MVP. CONCLUSION: Our data show that PR interval may be used as a selection criterion to identify the optimal physiological pacing mode. Persistent AF incidence was lower in short PR patients treated by right ventricular pacing minimization and in long PR patients treated by standard dual-chamber pacing. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Ondřej Toman; Katerina Hnatkova; Peter Smetana; Katharina M Huster; Martina Šišáková; Petra Barthel; Tomáš Novotný; Georg Schmidt; Marek Malik Journal: Sci Rep Date: 2020-02-13 Impact factor: 4.379