Cardiac resynchronization therapy improves left ventricular remodeling and function compared with right ventricular pacing in patients with atrioventricular block

Abstract

Right ventricular pacing (RVP) exerts a detrimental effect on left ventricular (LV) remodeling. In patients with atrioventricular block (AVB) that require ventricular pacing, the effect of biventricular pacing (BiVP) versus RVP on LV remodeling and function has not been comprehensively assessed in a meta-analysis. Electric databases MEDLINE and Cochrane Library were retrieved for randomized controlled trials (RCT) comparing RVP and BiVP in patients with AVB. Data on left ventricular ejection fraction (LVEF) and LV volumes were analyzed, stratified by different time points. Eleven RCTs were included in the final analysis. There was a significant reduction of LV end-systolic volume in BiVP compared with RVP, at 3, 6, 12, and 24 months follow-up (P < 0.05 for all). BiVP was associated with a decreased LV end-diastolic volume in comparison to RVP at 3, 6, and 12 months. Compared with RVP, BiVP had a higher LVEF at all follow-up visits, with mean difference of 5.91, 3.29, 3.9, 6.66, and 8.69% at 3, 6, 12, 24, and beyond 24 months follow-up, respectively. The results were not significantly changed in sensitivity analysis after removal of studies with mean baseline LVEF < 50% or excluding studies with ablation-induced AVB. In patients with AVB and bradycardia that require ventricular pacing, BiVP is superior to RVP in improving LV remodeling and function.

Keywords: Atrioventricular block heart failure; Cardiac remodeling; Cardiac resynchronization therapy.