Pacing Mode Choice (Atrioventricular block)

Title of Trial
United Kingdom Pacing and Cardiovascular Events (UKPACE) Trial

Initial Presentation
American College of Cardiology 2003

Date and Citation of Primary Publication(s) or References
Pending

Purpose of the Trial
Evaluate the effects of pacing mode choice in elderly patients with atrioventricular block.

Study Category
Pacing

Patient Population
Inclusion Criteria
Age > 70 years, AV block

Exclusion Criteria
Established atrial fibrillation, severe cognitive dysfunction, total immobility, NYHA class IV heart failure, or advanced malignancy.

Study Design
Randomized controlled trial. Patients randomized to VVI, VVIR, or DDDR pacing modes.

Primary Endpoints
All cause mortality

Secondary Endpoints
stroke, quality-of-life, exercise tolerance

Baseline Characteristics
Patient number: 2,021 patients (DDDR: 1012; VVI: 504; VVIR: 505)
Mean Age: 80 years
Gender: Not available
Other characteristics: Not available

Time to Follow-up
Mortality: 4.6 years, Other endpoints: 3 years.

Results
No difference in mortality among the different pacing modes. No difference in stroke or transient ischemic attacks between ventricular pacing (VVI and VVIR pacing modes) and dual chamber pacing modes (Table). However, an increase in stroke and TIA was associated with the DDDR pacing mode compared to the VVI pacing mode (Hazard ratio: 1.58; p=0.035). Incidence of heart failure (VVI: 8%; VVIR: 11%, DDDR: 10%) or myocardial infarction (VVI: 3%; VVIR: 2%, DDDR: 3%) was not different between the three pacing modes.

	Hazard ratio	P
Mortality (VVI/VVIR vs. DDDR)	0.96	0.56
Mortality (VVI vs. DDDR)	1.03	0.74
Mortality (VVIR vs. DDDR)	0.89	0.22
Stroke or TIA (VVI/VVIR vs. DDDR)	1.28	0.20

Sponsor
British Heart Foundation

Trial Status: Completed, presented, but not published