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PACE: A trial that challenges dogma

Posted Nov 24, 2009 at 01:50 PM, EDT by Eric Topol

This well designed trial sought to find out whether placing a right ventricular lead at the apex--as per standard pacing procedure--leads to adverse cardiac remodeling and hence could promote heart failure and cardiac death. The results not only challenge dogma but pose a dilemma for clinical practice. How do you interpret the PACE trial? What are your thoughts?

See:

PACE: BiV pacing protects against RV pacing's adverse ventricular effects in randomized trial

Cheuk-Man Y, Yat-Sun Chan J, Zhang Q, et al. Biventricular pacing in patients with bradycardia and normal ejection fraction. N Engl J Med 2009; DOI: 10.1056/NEJMoa0907555. Available at: http://www.nejm.org.

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Dear Dr.Topol,

In our clinic ( 700 pacing device implantations annually ) like in most high volume centers RV apical pacing has been abandoned for many years. The alternative has been RV septal pacing which desynchronizes the electrical activation of the LV much less than RV apical pacing. Only the patients with LBBB, wide QRS and poor LV function really need bivenricular pacing. So patients with heart block and normal LV function can be managed with DDD RV septal pacing.

Best regards

Sami Pakarinen, MD

Helsinki University Central Hospital, Finland, Europe


Posted by Sami Pakarinen, MD, Mar 18, 2010 at 01:00 PM, EDT
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