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)

https://doi.org/10.1016/j.jacc.2005.12.056Get rights and content
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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.

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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