| Title: | AV-optimized conduction system pacing for treatment of AV dromotropathy : a randomized, cross-over study |
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| Authors: | ID Zupan Mežnar, Anja (Author)
ID Mrak, Miha (Author)
ID Mullens, Wilfried (Author)
ID Štublar, Jernej (Author)
ID Ivanovski, Maja (Author)
ID Žižek, David (Author) |
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| Files: |  PDF - Presentation file, download (1,95 MB)
MD5: 0A360DEC8BBF0C5F9C7A441A9CE71C27
 URL - Source URL, visit https://onlinelibrary.wiley.com/doi/10.1111/jce.16268
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| Language: | English |
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| Typology: | 1.01 - Original Scientific Article |
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| Organization: |  UKC LJ - Ljubljana University Medical Centre
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| Abstract: | Background: Severe first-degree atrioventricular (AV) block may produce symptoms similar to heart failure due to AV dyssynchrony, a syndrome termed AV dromotropathy. According to guidelines, it should be considered for permanent pacemaker implantation, yet evidence supporting this treatment is scarce. Objectives: This study aimed to determine the impact of AV-optimized conduction system pacing (CSP) in patients with symptomatic severe first-degree AV block and echocardiographic signs of AV dyssynchrony. Methods: Patients with symptomatic first-degree AV block (PR > 250 ms), preserved left ventricular ejection fraction, narrow QRS, and AV dyssynchrony were included in the study. In a single-blind cross-over design, patients were randomized to AV sequential CSP or backup VVI pacing with a base rate of 40 bpm. We compared exercise capacity, echocardiographic parameters, and symptom occurrence at the end of 3 months of each period. Results: Fourteen patients completed the study. During the AV-optimized CSP compared to the backup pacing period, patients achieved a higher workload on exercise test (147.2 ± 50.9 vs. 140.7 ± 55.8 W; p = .032), with a trend towards higher peak VO2 (23.3 ± 7.1 vs. 22.8 ± 7.1 mL/min/kg; p = .224), and higher left ventricular stroke volume (LVSV 74.5 ± 13.8 vs. 66.4 ± 12.5 mL; p < .001). Symptomatic improvement was recorded, with fewer patients reporting general tiredness and 71% of patients preferring the AV-optimized CSP (p = .008). Conclusions: AV-optimized CSP could improve symptoms, exercise capacity and LVSV in patients with severe first-degree AV block |
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| Keywords: | AV coupling, AV dromotropathy, AV dyssynchrony, conduction system pacing, first‐degree AV block |
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| Publication status: | Published |
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| Publication version: | Version of Record |
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| Year of publishing: | 2024 |
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| Number of pages: | str. 1340-1350 |
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| Numbering: | Vol. 35, iss. 7 |
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| PID: | 20.500.12556/DiRROS-30011  |
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| UDC: | 616.1:602.621 |
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| ISSN on article: | 1045-3873 |
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| DOI: | 10.1111/jce.16268 |
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| COBISS.SI-ID: | 203663107 |
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| Publication date in DiRROS: | 11.06.2026 |
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| Views: | 50 |
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| Downloads: | 36 |
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