Chronic right ventricular apical pacing: Adverse effects and current therapeutic strategies to minimize them

Åkerström, Finn; Pachón, Marta; Puchol, Alberto; Jiménez‐López, Jesús; Segovia, Diana; Rodríguez‐Padial, Luis; Arias, Miguel Á.

doi:10.1016/j.ijcard.2014.03.079

Cited by 49 publications

(45 citation statements)

References 81 publications

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“…1 The development of artificial permanent pacemakers (PPMs) for electrical control of cardiac rhythm has greatly enhanced a physician's ability to treat cardiac dysrhythmias including sick sinus syndrome (SSS) and complete atrioventricular block (CAVB) and reduced cardiac morbidity and mortality related to symptomatic bradycardia. 2 However, chronic right ventricular (RV) pacing-related pacing-induced cardiomyopathy (PICM) has a potentially deleterious effect on left ventricular (LV) performance. 3,4 According to previous reports, pacing anatomical site, pacing percentage, and pre-implantation LV performance affect the occurrence of PICM and its subsequent clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

Post‐pacemaker implant QRS duration and heart failure admission in patients with sick sinus syndrome and complete atrioventricular block

et al. 2019

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Aims High demand right ventricular pacing may elicit left ventricular systolic dysfunction known as pacing‐induced cardiomyopathy, increasing the risks of heart failure (HF) hospitalization. Percentage of demand ventricular pacing is different between patients with sick sinus syndrome (SSS) and those with complete atrioventricular block (CAVB). This study aims to compare the incidence of HF admission and pacing‐induced cardiomyopathy between patients with SSS and CAVB. Methods and results A total of 824 patients who received single ventricular or dual‐chamber pacemaker implantation at our hospital between January 2003 and December 2012 were recruited for the study. Patients with HF, those without complete cardiac echocardiography, and those with significant coronary artery disease were excluded. Finally, 315 patients with SSS and 289 patients with CAVB were enrolled in this study. The CAVB group had a higher pacing percentage (39.37 ± 9.17% vs. 83.82 ± 33.06%; P < 0.001), longer pacing QRS duration (142.56 ± 33.02 ms vs. 156.63 ± 25.18 ms; P < 0.001), and higher prevalence of follow‐up left ventricular ejection fraction ≤40% (1.3% vs. 4.2%; P = 0.040). However, the incidence of HF admission was similar between the two groups (log‐rank P = 0.647). Age [hazard ratio (HR), 95% confidence interval (CI): 1.121, 1.054–1.193], diabetes mellitus (HR, 95% CI: 2.667, 1.159–6.136), pacing QRS duration ≥163 ms (HR, 95% CI: 3.506, 1.491–8.247), and left atrial size (HR, 95% CI: 1.070, 1.012–1.131) were independent predictors of HF admission. The Kaplan–Meier curve showed a significant difference in HF admission over a 3.5 year follow‐up period (3.5 years: P value = 0.004; 5 years: P value = 0.002) between patients with pacing QRS duration ≥163 and <163 ms. Conclusions There was no difference in HF admission between patients with SSS and CAVB, although the CAVB group had a higher pacing percentage. Post‐pacemaker implant pacing QRS duration ≥163 ms was the most important predictor of HF admission.

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Section: Introductionmentioning

confidence: 99%

Post‐pacemaker implant QRS duration and heart failure admission in patients with sick sinus syndrome and complete atrioventricular block

et al. 2019

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“…Changes in depolarization or repolarization or other signs of adverse pacing effects may be detected at an early stage. Various studies have demonstrated that long-term ventricular pacing may have various unintended adverse electrophysiological and mechanical effects [21, 22]. In order to better understand the underlying (patho-) physiological mechanisms, it is important to further develop clinically applicable, non-invasive techniques that facilitate an integrated electro-mechanical assessment.…”

Section: Discussionmentioning

confidence: 99%

Non-invasive focus localization, right ventricular epicardial potential mapping in patients with an MRI-conditional pacemaker system ‐ a pilot study

Graaf

Bhagirath

Hooge

et al. 2015

J Interv Card Electrophysiol

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BackgroundWith the advent of magnetic resonance imaging (MRI) conditional pacemaker systems, the possibility of performing MRI in pacemaker patients has been introduced. Besides for the detailed evaluation of atrial and ventricular volumes and function, MRI can be used in combination with body surface potential mapping (BSPM) in a non-invasive inverse potential mapping (IPM) strategy. In non-invasive IPM, epicardial potentials are reconstructed from recorded body surface potentials (BSP). In order to investigate whether an IPM method with a limited number of electrodes could be used for the purpose of non-invasive focus localization, it was applied in patients with implanted pacing devices. Ventricular paced beats were used to simulate ventricular ectopic foci.MethodsTen patients with an MRI-conditional pacemaker system and a structurally normal heart were studied. Patient-specific 3D thorax volume models were reconstructed from the MRI images. BSP were recorded during ventricular pacing. Epicardial potentials were inversely calculated from the BSP. The site of epicardial breakthrough was compared to the position of the ventricular lead tip on MRI and the distance between these points was determined.ResultsFor all patients, the site of earliest epicardial depolarization could be identified. When the tip of the pacing lead was implanted in vicinity to the epicardium, i.e. right ventricular (RV) apex or RV outflow tract, the distance between lead tip position and epicardial breakthrough was 6.0 ± 1.9 mm.ConclusionsIn conclusion, the combined MRI and IPM method is clinically applicable and can identify sites of earliest depolarization with a clinically useful accuracy.Electronic supplementary materialThe online version of this article (doi:10.1007/s10840-015-0054-9) contains supplementary material, which is available to authorized users.

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“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14]16 We felt that addressing these alterations were beyond the scope of this clinical review.…”

Section: Mechanismsmentioning

confidence: 99%

“…Frequent RV pacing alters geometry and function of the LV on multiple levels resulting in a variety of manifestations. [1][2][3][4][5][6][7][8][9][10][11][12] Long-term mandatory (100%) RV pacing, increases LV dimensions (end diastolic and end systolic), LV mass, and left atrial diameter. It also decreases LV ejection fraction (LVEF), and worsens mitral regurgitation.…”

mentioning

confidence: 99%

The Role of Biventricular Pacing in the Prevention and Therapy of Pacemaker‐Induced Cardiomyopathy

Guglin

Barold

2015

Noninvasive Electrocardiol

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Right ventricular (RV) pacing produces well-known long-term deleterious effects not only on already compromised, but also on the normal left ventricle (LV). The activation pattern mimicks that of left bundle branch block, with delayed activation of the LV free wall, and results in electrical and mechanical dyssynchrony. Long-term mandatory (100%) RV pacing, increases LV dimensions and decreases the ejection fraction. Many of these negative effects of pacing can be overcome by biventricular pacing. In this review, we describe the characteristics of pacemaker-induced cardiomyopathy, its incidence, and the use of cardiac resynchronization therapy (CRT) for its therapy and prevention. The gaps in the current organizational guidelines for using CRT in the treatment of bradycardia are identified, and goals for future research are discussed.

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Chronic right ventricular apical pacing: Adverse effects and current therapeutic strategies to minimize them

Cited by 49 publications

References 81 publications

Post‐pacemaker implant QRS duration and heart failure admission in patients with sick sinus syndrome and complete atrioventricular block

Post‐pacemaker implant QRS duration and heart failure admission in patients with sick sinus syndrome and complete atrioventricular block

Non-invasive focus localization, right ventricular epicardial potential mapping in patients with an MRI-conditional pacemaker system ‐ a pilot study

The Role of Biventricular Pacing in the Prevention and Therapy of Pacemaker‐Induced Cardiomyopathy

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