0184: Clinical benefit of the safer mode in a mixed dual chamber population: results from the ANSWER study

Introduction Several studies have shown that unnecessary right ventricular pacing (Vp) has detrimental effects. The ANSWER study evaluated whether minimization of Vp improves clinical outcome compared to standard DDD pacing in patients (pts) referred for dual chamber pacemaker implantation. Methods ANSWER is a randomized, long term follow-up, multicenter, international trial comparing SafeR, a mode designed to minimize Vp by promoting intrinsic conduction, to standard DDD (AV delay left to physician’s discretion). Pts enrolled suffered from sinus node disease (SND), intermittent AV block (AVB) or allegedly permanent AVB. All pts were programmed in SafeR at implant. 1 month after implant, pts were randomized 1:1 to either SafeR or DDD. All adverse events were blindly adjudicated by a Clinical Event Committee. Secondary endpoints, presented here, included a composite of cardiac deaths and HF hospitalizations and cardiovascular (CV) hospitalizations, at 3 years. Treatment groups were compared based on an intention-totreat principle. Results 650 pts were enrolled in 43 centers in 7 countries (72.4±11.2 years, 55.2% males, 52.0% SND, 41.8% intermittent AVB and 6.2% permanent AVB) and implanted with a dual chamber pacemaker. 632 pts were randomized (314 in SafeR and 318 in DDD). Median%Vp was 11.5% in SafeR vs. 93.6% in DDD (p Conclusion As compared to DDD, the SafeR pacing mode significantly increased the time to cardiac death or first HF hospitalization, the time to first CV hospitalization and significantly reduced the duration of hospitalizations for any CV reason. Download full-size image Abstract 0184 - Figure: Kaplan Meier curve of CV hospitalizations