Abstract 17243: Increased Survival in Patients with Right Ventricular Pacemakers Treated with Renin-Angiotensin-Aldosterone System Blockade
Background: Right ventricular apical pacing can cause ventricular dyssynchrony and pacing-induced heart disease that is associated with worse cardiovascular outcomes. In an animal pacing model angiotensin converting enzyme inhibitors (ACEI) diminished left ventricular dyssynchrony reduction in afterload and left-ventricular wall stress and reduction in myocardial fibrosis. The impact of ACEI in paced patients is unknown.
Objectives: To investigate the impact of ACEI/ARB on survival in a retrospective observational study of paced patients.
Methods: The Tayside Pacemaker Registry was linked to dispensed prescribing, laboratory, echocardiography, hospital admission data as well as and the national death registry. All patients undergoing right ventricular pacemaker insertion between 1994 and 2009 who had never received ACE-I/ARB prior to pacing were included. Patients with heart failure prior to implant were excluded. Cox regression was used to assess differences in all-cause mortality between those on ACE-I/ARB versus those who had never received ACE-I/ARB, adjusted for confounding variables. A propensity score matched analysis was performed to minimise bias.
Results: 3815 patients implanted between 1994 and 2008, 1186 (median age 78, range 18-103yrs, 53% males) met inclusion criteria (63% DDD and 37% VVI). Mean follow-up was 5.3 ± 4.0 years with 484 (41%) deaths. ACEI/ARB was associated with significantly reduced mortality (adjusted HR 0.68, 95%CI [0.54-0.87],p<0.001). In a propensity score matched analysis of 805 individuals the HR was (0.57, 95%CI [0.46-0.71], p=0.001).
Conclusions: This study suggests prescription of ACEI/ARBs may confer benefits on survival in patients with right ventricular pacemakers.
- © 2011 by American Heart Association, Inc.