Biventricular pacing superior to RV pacing for AV block with systolic dysfunction

Biventricular pacing superior to RV pacing for AV block with systolic dysfunction

It is known that right ventricular apical pacing can result in deterioration of left ventricular systolic function in the long run due to dyssynchrony of left ventricular contraction. The BLOCK-HF (Biventricular Versus Right Ventricular Pacing in Heart Failure Patients With Atrioventricular Block) study [1] evaluated the role of biventricular pacing (BiV, cardiac resynchronization therapy or CRT) compared to right ventricular (RV) pacing for those with AV block and left ventricular ejection fraction (LVEF) of 50% or less and in NYHA classes I to III. The study documented that the composite endpoint of death, heart failure-related urgent care, and adverse left ventricular remodeling were lower in BiV group compared to right ventricular pacing. This further translated into improved quality of life and heart failure status at one year. The improvement in clinical composite score persisted through two years of follow up as well.

The study could be sufficient reason for recommending BiV in those with reduced left ventricular function and atrioventricular block with indication for permanent pacing.

Reference

1. Curtis AB, Worley SJ, Chung ES, Li P, Christman SA, St John Sutton M. Improvement in Clinical Outcomes With Biventricular Versus Right Ventricular Pacing. The BLOCK HF Study. Am Coll Cardiol. 2016;67(18):2148-2157.