CoChat
Sign Up
Cited by 2,056Cardiac pacing and defibrillation studiesCardiac electrophysiology and arrhythmiasCardiac Arrest and Resuscitation

Dual-Chamber Pacing or Ventricular Backup Pacing in Patients With an Implantable Defibrillator: The Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial

Open access
The DAVID Trial Investigators*·2002·JAMA
DOI 10.1001/jama.288.24.3115
Open this paper in CoChat — free accountOpen PDF

Abstract

CONTEXT: Implantable cardioverter defibrillator (ICD) therapy with backup ventricular pacing increases survival in patients with life-threatening ventricular arrhythmias. Most currently implanted ICD devices provide dual-chamber pacing therapy. The most common comorbid cause for mortality in this population is congestive heart failure. OBJECTIVE: To determine the efficacy of dual-chamber pacing compared with backup ventricular pacing in patients with standard indications for ICD implantation but without indications for antibradycardia pacing. DESIGN: The Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial, a single-blind, parallel-group, randomized clinical trial. SETTING AND PARTICIPANTS: A total of 506 patients with indications for ICD therapy were enrolled between October 2000 and September 2002 at 37 US centers. All patients had a left ventricular ejection fraction (LVEF) of 40% or less, no indication for antibradycardia pacemaker therapy, and no persistent atrial arrhythmias. INTERVENTIONS: All patients had an ICD with dual-chamber, rate-responsive pacing capability implanted. Patients were randomly assigned to have the ICDs programmed to ventricular backup pacing at 40/min (VVI-40; n = 256) or dual-chamber rate-responsive pacing at 70/min (DDDR-70; n = 250). Maximal tolerated medical therapy for left ventricular dysfunction, including angiotensin-converting enzyme inhibitors and beta-blockers, was prescribed to all patients. MAIN OUTCOME MEASURE: Composite end point of time to death or first hospitalization for congestive heart failure. RESULTS: One-year survival free of the composite end point was 83.9% for patients treated with VVI-40 compared with 73.3% for patients treated with DDDR-70 (relative hazard, 1.61; 95% confidence interval [CI], 1.06-2.44). The components of the composite end point, mortality of 6.5% for VVI-40 vs 10.1% for DDDR-70 (relative hazard, 1.61; 95% CI, 0.84-3.09) and hospitalization for congestive heart failure of 13.3% for VVI-40 vs 22.6% for DDDR-70 (relative hazard, 1.54; 95% CI, 0.97-2.46), also trended in favor of VVI-40 programming. CONCLUSION: For patients with standard indications for ICD therapy, no indication for cardiac pacing, and an LVEF of 40% or less, dual-chamber pacing offers no clinical advantage over ventricular backup pacing and may be detrimental by increasing the combined end point of death or hospitalization for heart failure.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1001/jama.288.24.3115

Cites

24 of 24 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Beta-blockers may slow atrioventricular conduction with resultant increases in right ventricular pacing, which can worsen heart failure owing to the loss of ventricular synchrony.

    “Finally, β-blockers may slow atrioventricular conduction with resultant increases in right ventricular pacing, which can worsen heart failure owing to the loss of ventricular synchrony.79”

    From Managing with pacemakers and implantable cardioverter defibrillators (2013) · cites this paper as [79]

    The discussion (page unavailable in our copy) says right ventricular stimulation may increase heart failure through ventricular desynchronization. It also describes β-blockers as having negative chronotropic effects, but does not say they slow atrioventricular conduction or thereby increase right ventricular pacing. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Part of this paper’s reference list could not be split into single entries.

Flagged first, then by citations

Research works printed but not linked: 5

  1. [16]16. East 2000-Software for the Design and Interim Monitoring of Group Sequential Clinical Trials User Manual. Cambridge, Mass: Cytel Soft- ware Corp; 2001.
  2. [18]18. Nambi V, Kalahasti V, Wilkoff B, et al. Paradoxic higher mortality associated with dual-chamber com- pared to single-chamber ICDs in patients with severe ischemic cardiomyopathy: possible role of pacing- induced QRS prolongation [abstract]. Pacing Clin Elec- trophysiol. 2002;25:642.
  3. [19]19. Andersen HR, Nielsen JC, Thomsen PE, et al. Long- term follow-up of patients from a randomized trial of atrial versus ventricular pacing for sick-sinus syn- drome. Lancet. 1997;350:1210-1216.
  4. [21]21. Kerr C, Connolly S, Roberts R, et al. Effect of pac- ing mode on cardiovascular death and stroke: the Ca- nadian Trial of Physiologic Pacing: Long Term Fol- low-up [abstract]. Pacing Clin Electrophysiol. 2002; 25:553.
  5. [22]22. Sweeney M, Hellkamp A, Greenspon A, et al. Base- line QRS duration Ն120 milliseconds and cumulative percent time ventricular paced predicts increased risk of heart failure, stroke, and death in DDDR-paced pa- tients with sick sinus syndrome in MOST [abstract]. Pacing Clin Electrophysiol. 2002;25:690.

Cited by

Sorted by citations

Related

Authors
The DAVID Trial Investigators*
Affiliations
Cleveland Clinic (US)
Corresponding author
The DAVID Trial Investigators*
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2002-12-25
Volume
288
Issue
24
Pages
3115
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.288.24.3115
OpenAlex
W1431873634
Semantic Scholar
bb3c308163481cd79e5329de27e9d66d6e0c0b50
Cited by
2,056
References
24
Citations by year
2026: 44 · 2025: 52 · 2024: 47 · 2023: 73 · 2022: 64 · 2021: 68 · 2020: 59 · 2019: 51 · 2018: 75 · 2017: 80 · 2016: 77 · 2015: 70 · 2014: 99 · 2013: 104 · 2012: 102
FWCI
55.67
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
  • Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
Keywords
implantable cardioverter-defibrillator, DDD pacing, VVI pacing, DDDR pacing, mortality, left ventricular dysfunction, rate-responsive pacing, left ventricular ejection fraction, heart failure prevention, ventricular arrhythmias, antibradycardia pacing
MeSH terms
Adrenergic beta-Antagonists, Aged, Amiodarone, Angiotensin-Converting Enzyme Inhibitors, Anti-Arrhythmia Agents, Anticoagulants, Arrhythmias, Cardiac, Cardiac Pacing, Artificial, Cardiovascular Agents, Digoxin, Diuretics, Female, Heart Failure, Humans, Male, Middle Aged, Pacemaker, Artificial, Warfarin, Survival Analysis, Single-Blind Method, Catheter Ablation, Defibrillators, Implantable, Tachycardia, Ventricular, Ventricular Dysfunction, Left

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review