Biventricular Versus Conventional Right Ventricular Stimulation for Patients With Standard Pacing Indication and Left Ventricular Dysfunction: The Homburg Biventricular Pacing Evaluation (HOBIPACE)

doi:10.1016/j.jacc.2005.12.056

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J Am Coll Cardiol, 2006; 47:1927-1937, doi:10.1016/j.jacc.2005.12.056 (Published online 20 April 2006).
© 2006 by the American College of Cardiology Foundation

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CLINICAL RESEARCH: CLINICAL TRIAL

Biventricular Versus Conventional Right Ventricular Stimulation for Patients With Standard Pacing Indication and Left Ventricular Dysfunction

The Homburg Biventricular Pacing Evaluation (HOBIPACE)

Michael Kindermann, MD^_*^,_*, Benno Hennen, MD^_*, Jens Jung, MD, Jürgen Geisel, MD, Michael Böhm, MD^_* and Gerd Fröhlig, MD^_*

^_* Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
Innere Klinik I, Stadtkrankenhaus, Worms, Germany
Klinisch-Chemisches Zentrallabor, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany

Manuscript received September 25, 2005; revised manuscript received December 1, 2005, accepted December 5, 2005.

^_* Reprint requests and correspondence: Dr. Michael Kindermann, Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, D 66421 Homburg/Saar, Germany (Email: Michael.Kindermann{at}t-online.de).

OBJECTIVES: The Homburg Biventricular Pacing Evaluation (HOBIPACE) is thefirst randomized controlled study that compares the biventricular(BV) pacing approach with conventional right ventricular (RV)pacing in patients with left ventricular (LV) dysfunction anda standard indication for antibradycardia pacing in the ventricle.

BACKGROUND: In patients with LV dysfunction and atrioventricular block,conventional RV pacing may yield a detrimental effect on LVfunction.

METHODS: Thirty patients with standard indication for permanent ventricularpacing and LV dysfunction defined by an LV end-diastolic diameter $≥$ 60 mm and an ejection fraction $≤$ 40% were included. Using a prospective,randomized crossover design, three months of RV pacing werecompared with three months of BV pacing with regard to LV function,N-terminal pro-B-type natriuretic peptide (NT-proBNP) serumconcentration, exercise capacity, and quality of life.

RESULTS: When compared with RV pacing, BV stimulation reduced LV end-diastolic(–9.0%, p = 0.022) and end-systolic volumes (–16.9%,p < 0.001), NT-proBNP level (–31.0%, p < 0.002),and the Minnesota Living with Heart Failure score (–18.9%,p = 0.01). Left ventricular ejection fraction (+22.1%), peakoxygen consumption (+12.0%), oxygen uptake at the ventilatorythreshold (+12.5%), and peak circulatory power (+21.0%) werehigher (p < 0.0002) with BV pacing. The benefit of BV overRV pacing was similar for patients with (n = 9) and without(n = 21) atrial fibrillation. Right ventricular function wasnot affected by BV pacing.

CONCLUSIONS: In patients with LV dysfunction who need permanent ventricularpacing support, BV stimulation is superior to conventional RVpacing with regard to LV function, quality of life, and maximalas well as submaximal exercise capacity.

Abbreviations and Acronyms
  AV = atrioventricular
  BV = biventricular
  DAVID = Dual Chamber and VVI Implantable Defibrillator trial
  HOBIPACE = Homburg Biventricular Pacing Evaluation
  LV = left ventricle/ventricular
  LVS = left ventricular synchrony
  LVS-SD = standard deviation of left ventricular synchrony
  MOST = Mode Selection Trial
  NT-proBNP = N-terminal pro-B-type natriuretic peptide
  NYHA = New York Heart Association
  PAVE = Post-Atrioventricular Nodal Ablation Evaluation
  RV = right ventricle/ventricular

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