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BIOPACE: Biventricular pacing not superior to RV pacing in patients with heart block

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BARCELONA, Spain — Biventicular pacing did not significantly improve outcomes compared with right ventricular pacing in patients with atrioventricular block, according to preliminary findings from the BIOPACE trial.

However, researchers found a nonsignificant trend in favor of biventricular pacing in that population. “Additional analyses will perhaps identify subgroups for which [biventricular pacing] confers a clear benefit,” Jean-Jacques Blanc, MD, said during a press conference at ESC Congress.

Blanc, from Brest University in France, and colleagues investigated whether biventricular pacing would benefit patients with atrioventricular block, who are typically treated with right ventricular (RV) pacing, which previous research has shown may have adverse effects on left ventricular function and clinical outcomes.

From May 2003 to September 2007, the researchers randomly assigned 1,810 patients with atrioventricular block (mean age, 73.5 years; mean LV ejection fraction, 55.4%) to RV pacing (n=908) or biventricular pacing (n=902). The primary endpoint was a composite of time to death or first hospitalization due to HF. Mean follow-up was 5.6 years.

Blanc and colleagues observed 688 combined events during the study period. The event-free rate for the primary endpoint did not significantly differ between the groups (HR=0.87; 95% CI, 0.75-1.01).

The researchers also observed no significant difference between the groups in the primary outcome among patients with LVEF ≤50% (n=571; HR=0.92; 95% CI, 0.73-1.16) and patients with LVEF >50% (n=1,239; HR=0.88; 95% CI, 0.72-1.07).

Initial implants failed in 14.8% of those in the biventricular pacing group vs. none in the RV pacing group, according to the researchers.

For more information:

Blanc J-J. Hot Line III. Heart Failure: Devices and Interventions. Presented at: the European Society of Cardiology Congress; Aug. 30-Sept. 3, 2014; Barcelona, Spain.

Disclosure: The study was funded by St. Jude Medical. Blanc reports consulting for St. Jude Medical.