Tri-Ventricular Pacing Had Lower All-Cause Mortality, Transplants

Tri-ventricular pacing (Tri-V) was associated with improved long-term survival and a lower incidence of ventricular arrhythmia burden compared with bi-ventricular pacing (Bi-V), according research published in JACC: Clinical Electrophysiology.

In a propensity score-matched cohort study, Rui Providencia, MD, PhD of Bart’s Heart Centre in London, and colleagues compared implanted tri-ventricular devices with implanted bi-ventricular devices in patients with advanced heart failure. Both groups included 34 patients and patients were followed during a total of 413 patient-years.

During follow-up, 16 patients in the Tri-V group died, 21 in the Bi-V group died, and 1 patient from the Bi-V group underwent heart transplant. Overall incidence for all-cause mortality or heart transplant was 9.17 per 100 patient-years (95% confidence interval [CI]: 6.75-12.33).

Researchers observed a trend for lower all-cause mortality and heart transplant in the Tri-V group (6.99 per 100 patient-years vs 11.92 per 100 patient-years; P=.059).

In the intention to treat analysis comparing all 45 patients implanted with Tri-V vs 45 Bi-V controls, Dr Providencia and colleagues observed lower all-cause mortality and heart transplant in the Tri-V group (hazard ratio [HR]: 0.55; 95% CI: 0.32-0.94; P=.029).

Nearly half of the patients (47.1%) experienced at least one incident of ventricular tachycardia/ventricular fibrillation requiring intervention with an implantable cardioverter defibrillator (incidence: 9.70 per 100 patient-years; 95% CI: 7.91-11.84). These arrhythmia episodes occurred more than 2.5 times as often in the Bi-V group compared with the Tri-V group (16.88 per 100 patient-years vs 6.55 per 100 patient-years; P=.019; adjusted HR=0.31; 95% CI: 0.14-0.66; P=.002)).

Researchers also noted the incidence of safety-related events or complications was comparable between the 2 groups, with low incidence of lead failure, lead dislodgment, and infections. However, battery life was about 7 months shorter in the Tri-V group vs the Bi-V group (1758 ± 360 days vs 1993 ± 408 days, respectively; P=.072).

“These findings support the need of future long-term and sufficiently powered randomized controlled studies to assess the impact of this pacing modality on hard clinical outcomes like mortality and arrhythmic events,” the authors concluded.

Reference

Providencia R, Rogers D, Papageorgiou N, et al. Long-term results of tri-ventricular versus bi-ventricular pacing in heart failure: a propensity-matched comparison. JACC Clin Electrophysiol. 2016. doi:10.1016/j.jacep.2016.05.015.