CLINICAL RESEARCH: CLINICAL TRIALS
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;
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 the first randomized controlled study that compares the biventricular (BV) pacing approach with conventional right ventricular (RV) pacing in patients with left ventricular (LV) dysfunction and a 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 LV function.
METHODS: Thirty patients with standard indication for permanent ventricular pacing 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 were compared with three months of BV pacing with regard to LV function, N-terminal pro-B-type natriuretic peptide (NT-proBNP) serum concentration, 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%), peak oxygen consumption (+12.0%), oxygen uptake at the ventilatory threshold (+12.5%), and peak circulatory power (+21.0%) were higher (p < 0.0002) with BV pacing. The benefit of BV over RV pacing was similar for patients with (n = 9) and without (n = 21) atrial fibrillation. Right ventricular function was not affected by BV pacing.
CONCLUSIONS: In patients with LV dysfunction who need permanent ventricular pacing support, BV stimulation is superior to conventional RV pacing with regard to LV function, quality of life, and maximal as well as submaximal exercise capacity.
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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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May 27, 2008;
51(21):
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|
|
|
|
|
|
|
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|
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|
|
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|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
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|
|
|
|
|
|
|
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|
|
|
|
|
|
|
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J. Am. Coll. Cardiol.,
May 22, 2007;
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|
|
|
|
|
|
|
J. D. Burkhardt and B. L. Wilkoff
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Circulation,
April 24, 2007;
115(16):
2208 - 2220.
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[Full Text]
[PDF]
|
|
|
|
|
|
|
M. H. Schoenfeld
Contemporary Pacemaker and Defibrillator Device Therapy: Challenges Confronting the General Cardiologist
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February 6, 2007;
115(5):
638 - 653.
[Full Text]
[PDF]
|
|
|
|
|
|
|
H.-F. Tse and C.-P. Lau
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J. Am. Coll. Cardiol.,
October 17, 2006;
48(8):
1649 - 1651.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. H. Schoenfeld
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J. Am. Coll. Cardiol.,
May 16, 2006;
47(10):
1946 - 1948.
[Full Text]
[PDF]
|
|
|
|
