Table 1

Right Ventricular Pacing Versus Biventricular Pacing in Patients With AV Block

Study (Ref. #)PatientsDesignEndpointsOutcomes
AV block
 PACE (18)n = 177
LVEF >45%
Bradycardia (SND, AVB)
Prospective, randomized, double-blind, multicenter
CRT vs. RV
1- to 2-yr follow-up
LVEF
LVESV
1-yr: 62.2% ± 7.0% vs. 54.8% ± 9.1%; p < 0.001
2-yr: 62.9% ± 8.8% vs. 53.0% ± 10.1%; p < 0.001
1-yr: 27.6 ± 10.4 ml vs. 35.7 ± 16.3 ml; p < 0.001
2-yr: 25.3 ± 10.2 ml vs. 38.3 ± 20.3 ml; p < 0.001
 PREVENT HF (20)n = 108
LVEF 54 ± 12%
AV block, VP >80%
NYHA functional class I, II
Prospective, 1:1 randomized, multicenter
BVP vs. RVP (pacer/ICD)
12-month follow-up
Primary: change in LVEDV at 12 months
Secondary: LVESV, EF, HF hospitalization, mortality
No significant differences in volumes, EF, mortality, or HF
 Block-HF (19)n = 691
LVEF <50%
AV block
NYHA functional class I, II, III
Prospective, randomized, multicenter
BVP vs. RVP (pacer/ICD)
Mean follow-up of 37 months
Primary: composite of death, urgent care visit for HF, 15% increase in LVESVI45.8% vs. 55.6% (HR: 0.74; 95% CI: 0.60 to 0.90)
 BioPace (21)n = 1,810
Any LVEF
AV block
Prospective, randomized, multicenter
BVP vs. RVP
Mean follow-up of 5.6 yrs
Primary: composite of time to death, HF hospitalizationHR: 0.87; 95% CI: 0.75 to 1.01; p = 0.08
Nonstatistically significant trend toward BVP
AV node ablation
 PAVE (22)n = 184
Permanent AF
AV node ablation
Prospective, randomized, multicenter, BVP vs. RVP
6-month follow-up
6-min walk
QOL
LVEF %
82.9 ± 94.7 m vs. 61.2 ± 90.0 m; p = 0.04
No difference
0.46 ± 0.13 vs. 0.41 ± 0.13; p = 0.03
 AVAIL CLS/CRT (24)n = 108
Refractory AF
AV node ablation
Prospective, 2:2:1 randomized, BVP with CLS vs. BVP vs. RVP
6-month follow-up
LVEF, 6-min walk, QOL, mortalityLVEF improved significantly with BVP compared with baseline (56.1 ± 9.4% to 59.3 ± 7.7%; p < 0.05). No change in RV. No difference in 6-min walk, QOL, mortality
 Ablate and Pace in AF (25)n = 186
Permanent AF
AV node
Prospective, randomized, multicenter, echocardiography-guided CRT vs. RVP
Median follow-up of 20 months
Primary: composite of HF death, HF hospitalization11% vs. 26%; HR: 0.37; p = 0.005
No difference in total mortality

AF = atrial fibrillation; AV = atrioventricular; AVAIL CLS/CRT = AV Node Ablation With CLS and CRT Pacing Therapies for Treatment of AF trial; AVB = AV block; BioPace = Biventricular Pacing for Atrio-ventricular Block to Prevent Cardiac Desynchronization; BLOCK-HF = Biventricular versus RV Pacing in Heart Failure Patients with Atrioventricular Block; BVP = biventricular pacing; CI = credible interval; CLS = closed loop stimulation; CRT = cardiac resynchronization therapy; EF = ejection fraction; HF = heart failure; HR = hazard ratio; ICD = implantable cardioverter-defibrillator; LVEDV = left ventricular end-diastolic volume; LVEF = left ventricular ejection fraction; LVESV = left ventricular end-systolic volume; LVESVI = left ventricular end-systolic volume index; NYHA = New York Heart Association; PACE = Pacing to Avoid Cardiac enlargement trial; PAVE = left ventricular-based cardiac stimulation Post AV nodal ablation Evaluation; PREVENT HF = Prevent Heart Failure; QOL = quality of life; RV = right ventricle; RVP = right ventricular pacing; SND = sinus node dysfunction; VP = ventricular pacing.