BLOCK-HF
Trial question
What is the role of biventricular pacing in patients with AV block and LV systolic dysfunction?
Study design
Multi-center
Double blinded
RCT
Population
Characteristics of study participants
25.0% female
75.0% male
N = 691
691 patients (174 female, 517 male).
Inclusion criteria: patients with AV block with NYHA class I-III HF and LVEF ≤ 50%.
Key exclusion criteria: previous receipt of a cardiac implantable electrical device, unstable angina, acute MI, percutaneous or surgical coronary intervention within 30 days before enrollment, valvular disease with an indication for valve repair or replacement.
Interventions
N=349 biventricular pacing (cardiac-resynchronization pacemaker or ICD with pacing of both the ventricles).
N=342 conventional RV pacing (cardiac-resynchronization pacemaker or ICD with pacing of only the right ventricle).
Primary outcome
Death, urgent care visit for heart failure, or ≥ 15% elevation in left ventricular end-systolic volume index
45.8%
55.6%
55.6 %
41.7 %
27.8 %
13.9 %
0.0 %
Biventricular
pacing
Conventional right ventricular
pacing
Significant
decrease ▼
NNT = 10
Significant decrease in death, urgent care visit for HF, or ≥ 15% elevation in the LV end-systolic volume index (45.8% vs. 55.6%; HR 0.74, 95% CI 0.6 to 0.9).
Safety outcomes
Significant difference in LV lead-related complications (6.4%).
Conclusion
In patients with AV block with NYHA class I-III HF and LVEF ≤ 50%, biventricular pacing was superior to conventional RV pacing with respect to death, urgent care visit for HF, or ≥ 15% elevation in the LV end-systolic volume index.
Reference
Curtis AB, Worley SJ, Adamson PB et al. Biventricular pacing for atrioventricular block and systolic dysfunction. N Engl J Med. 2013 Apr 25;368(17):1585-93.
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