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Randomized Controlled Trial
. 2010 Jan;12(1):96-102.
doi: 10.1093/europace/eup252.

Difference in percentage of ventricular pacing between two algorithms for minimizing ventricular pacing: results of the IDEAL RVP (Identify the Best Algorithm for Reducing Unnecessary Right Ventricular Pacing) study

Yoshimasa Murakami  1 , Naoya Tsuboi, Yasuya Inden, Yukihiko Yoshida, Toyoaki Murohara, Zenichi Ihara, Mitsuaki Takami
Affiliations
Randomized Controlled Trial

Difference in percentage of ventricular pacing between two algorithms for minimizing ventricular pacing: results of the IDEAL RVP (Identify the Best Algorithm for Reducing Unnecessary Right Ventricular Pacing) study

Yoshimasa Murakami et al. Europace. 2010 Jan.

Abstract

Aims: Managed ventricular pacing (MVP) and Search AV+ are representative dual-chamber pacing algorithms for minimizing ventricular pacing (VP). This randomized, crossover study aimed to examine the difference in ability to reduce percentage of VP (%VP) between these two algorithms.

Methods and results: Symptomatic bradyarrhythmia patients implanted with a pacemaker equipped with both algorithms (Adapta DR, Medtronic) were enrolled. The %VPs of the patients during two periods were compared: 1 month operation of either one of the two algorithms for each period. All patients were categorized into subgroups according to the atrioventricular block (AVB) status at baseline: no AVB (nAVB), first-degree AVB (1AVB), second-degree AVB (2AVB), episodic third-degree AVB (e3AVB), and persistent third-degree AVB (p3AVB). Data were available from 127 patients for the analysis. For all patient subgroups, except for p3AVB category, the median %VPs were lower during the MVP operation than those during the Search AV+ (nAVB: 0.2 vs. 0.8%, P < 0.0001; 1AVB: 2.3 vs. 27.4%, P = 0.001; 2AVB: 16.4% vs. 91.9%, P = 0.0052; e3AVB: 37.7% vs. 92.7%, P = 0.0003).

Conclusion: Managed ventricular pacing algorithm, when compared with Search AV+, offers further %VP reduction in patients implanted with a dual-chamber pacemaker, except for patients diagnosed with persistent loss of atrioventricular conduction.

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Figures

Figure 1
Figure 1
Comparisons of %VP in each operational period of the two algorithms by patient category: Boxplot graphs denote 90th and 10th percentiles (whiskers), 75th and 25th percentiles (boxes), medians (horizontal white lines in the boxes), and observations above 90th or below 10th percentile (circles). The values at the bottom of each graph denote median and mean (in parenthesis) %VPs in each operational period of the two algorithms. nAVB, no AV block; 1AVB, first-degree AV block; 2AVB, second-degree AV block; e3AVB, episodic third-degree AV block; p3AVB, persistent third-degree AV block.
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