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MVP: Atrial pacing does not improve outcomes in patients with ICDs

Longer baseline PR intervals were associated with an increased risk for worse outcomes

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Heart Rhythm Society's 30th Annual Scientific Sessions

Managed ventricular pacing yields no additional benefits compared with ventricular backup pacing in patients with implantable cardioverter defibrillators, results from a study suggested.

Researchers enrolled 1,031 patients with ICDs into the MVP study and randomly assigned them to receive either managed ventricular pacing at 60 beats per minute (n=518) or ventricular backup pacing at 40 beats per minute (n=513). The primary endpoint was time to death, HF hospitalization and HF-related urgent care. Patients were followed-up for a median of 25.8 months until the study was discontinued in July of 2008.

In patients with PR intervals >230 ms at baseline, no difference between atrial pacing and ventricular pacing was reported. The researchers also reported that for each 10 ms increase in the length of the baseline PR interval above the mean interval of 184 ms, atrial pacing was associated with a 12% increased risk for death and HF hospitalization. Patients in the managed ventricular pacing group with PR intervals >230 ms had daily atrial pacing between 30% and 40%, and patients with PR intervals <230 ms had atrial pacing between 20% and 25%. The mean percentage of daily ventricular pacing in patients with PR intervals >230 ms, according to the researchers, was between 5% and 10%.

“The MVP trial provides no evidence that atrial pacing improves outcomes in patients with ICDs, and yet, 5.5% of patients develop a need for bradycardia pacing during follow-up with an event rate about two points greater than VVI-40 versus the [managed ventricular pacing] group,” Michael O. Sweeney, MD, an electrophysiologist at Brigham and Women’s Hospital in Boston, said during his presentation. “Thus, despite four randomized clinical trials (DAVID, DAVID II, INTRINSIC-RV and MVP), which enrolled 3,125 patients over 10 years, the optimal a priori strategy for bradycardia patient support that is required or desired in typical patients with ICDs is still unknown.” – by Eric Raible

For more information:

• Sweeney MO. LBCT II. Presented at: Heart Rhythm 2009; May 13-16, 2009; Boston.