Evaluation of Ventricular Pacing Suppression Algorithms in Dual Chamber Pacemaker: Results of "LEADER" Study

Overview

Journal J Arrhythm

Publisher Wiley

Date 2024 Aug 14

PMID 39139897

Authors

Jongmin Hwang

Seongwook Han

Hyoung-Seob Park

Tae-Wan Chung

Minsu Jung

Seung-Jung Park

Chan-Hee Lee

Jin Hee Ahn

Eue-Keun Choi

Myung Hwan Bae

Young Soo Lee

Sang Won Park

Dae In Lee

Yoo-Ri Kim

Min-Soo Ahn

Jaemin Shim

Affiliations

Soon will be listed here.

Abstract

Background: There is limited research on the intra-individual efficacy of ventricular pacing minimization algorithms developed by Biotronik-the Ventricular Pace Suppression algorithm (VpS) and the Intrinsic Rhythm Support plus algorithm (IRSplus) (BIOTRONIK SE & Co. KG, Berlin, Germany). We performed a randomized pilot trial that evaluated the efficacy of two algorithms in patients with symptomatic sinus node dysfunction (SND) who received a dual-chamber pacemaker.

Methods: The trial was conducted in 11 tertiary hospitals in South Korea. The patients were randomized to either the VpS or IRSplus algorithm group after a 3-month period of fixed atrioventricular (AV) delay. The primary outcome was the ventricular pacing percentage (Vp%) at each follow-up visit. The secondary outcomes were the occurrence of heart failure (HF) and atrial fibrillation (AF) during the study period.

Results: Data from 131 patients were analyzed. Initially, their average Vp% over 3 months with a fixed AV interval was 14.1 ± 19.4%. Patients were randomly assigned to VpS and IRSplus groups, with 66 and 65 in each. Algorithms reduced average Vp% to 4.0 ± 11.3% at 9 months and 6.7 ± 14.9% at 15 months. These algorithms were more effective for patients with paced AV delay (PAVD) ≤300 ms compared to those with PAVD >300 ms. Both algorithms were equally effective in reducing Vp%. Clinical AF or HF hospitalization was not observed during the study period.

Conclusion: The VpS and IRSplus algorithms are effective and safe in minimizing unnecessary ventricular pacing in patients with SND.

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