Right Ventricular (RV) Pacing in Early Post-operative Continuous Flow Left Ventricular Assist Device (LVAD)

Continuous right ventricular (RV) pacing demonstrates harm in patients with normal left
ventricular (LV) function as well as in patients with cardiomyopathy and clinical heart
failure. However, little is known about RV pacing in patients with advanced HF treated with
an implantable left ventricular assist device (LVAD). The univentricular support provided by
contemporary continuous flow LVAD's has improved outcomes for many advanced heart failure
patients, yet the incidence of RV failure in the early post-operative period following
implantation is associated with significantly reduced survival and increased length of stay.
Acute LVAD unloading of the left ventricle has adverse effects on RV shape and size that
contribute to post-operative RV failure. By promoting RV synchrony, RV overdrive pacing may
counteract these adverse mechanical alterations, improving RV systolic function and
ultimately LVAD function.

The investigators will recruit all patients referred for an implantable, continuous flow
LVAD at Duke University Medical Center who have an existing implantable dual-chamber
cardioverter-defibrillator. Patients will be prospectively randomized into two cohorts to
compare continuous right ventricular pacing vs. native ventricular conduction at equivalent
heart rates. Multiple clinical outcomes will be examined over a two week period
post-operatively including invasive hemodynamics, vasoactive medication use, end-organ
function, RV function by Echocardiography as well as patient symptoms and functional status.