Long-term implications of cumulative right ventricular pacing among patients with an implantable cardioverter-defibrillator

Alon Barsheshet*, Arthur J. Moss, Scott McNitt, Christian Jons, Michael Glikson, Helmut U. Klein, David T. Huang, Jonathan S. Steinberg, Mary W. Brown, Wojciech Zareba, Ilan Goldenberg

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background Limited data regarding the effect of right ventricular pacing (RVP) on long-term survival following implantable cardioverter-defibrillator (ICD) implantation are available. Objective The purpose of this study was to evaluate the effect of RVP on the long-term survival benefit of primary ICD therapy. Methods Mortality data were obtained for all patients enrolled in the Multicenter Automatic Defibrillator Trial-II (MADIT-II) during an extended follow-up period of 8 years. The cumulative percent RVP during the trial was categorized as low (≤50% [n = 369]) and high (>50% [n = 198]). The benefit of ICD versus non-ICD therapy (n = 490) was evaluated in the two pacing categories during the early (03 years) and late (48 years) phases of the extended follow-up period. Results During the early phase of the extended follow-up period, ICD therapy was associated with similar benefits in the low-RVP and high-RVP subgroups (hazard ratio [HR] = 0.35 and 0.38, respectively, P <.001 for both). In contrast, during the late phase, the long-term survival benefit of the ICD was maintained among patients with low RVP (HR = 0.60, P <.001) and attenuated among those with the high RVP (HR = 0.89, P = .45). An increased risk for late mortality associated with high versus low RVP was evident only among patients without left bundle branch [LBBB] at enrollment (HR = 1.63, P = .002). Conclusion Among ICD recipients, high RVP is associated with a significant increase in the risk of long-term mortality and with attenuated device efficacy. The deleterious effects of RVP are pronounced mainly in non-LBBB patients, suggesting a possible role for combined cardiac resynchronizationdefibrillator therapy in this population.

Original languageEnglish
Pages (from-to)212-218
Number of pages7
JournalHeart Rhythm
Issue number2
StatePublished - Feb 2011
Externally publishedYes


  • Heart failure
  • Implantable cardioverter-defibrillator
  • Right ventricular pacing


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