Impact of simple electrocardiographic markers as predictors for deterioration of left ventricular function in patients with frequent right ventricular apical pacing

Abstract

Several trials demonstrated that frequent right ventricular apical pacing (RVAP) was associated with cardiac dysfunction and an increased rate of heart failure hospitalization. However, there are few reports about the 12-lead electrocardiogram (12-ECG) parameters at the time of device implantation to predict deterioration of LVEF in patients with frequent RVAP. We retrospectively studied 115 consecutive patients undergoing pacemaker or implantable cardioverter-defibrillator implantation with RVAP, with rate of ventricular pacing ≥ 40% and LVEF ≥ 50% at the time of implantation. We compared the 12-ECG characteristics at the time of device implantation between patients with deterioration of LVEF (≥ 10% reduction) and those without. Twenty-nine patients (25%) had deteriorated LVEF with a decrease in mean LVEF from 59 to 40% during a median follow-up period of 8.9 [4.6-13.7] years. Multivariate logistic regression analysis showed that cumulative % of ventricular pacing [odds ratio (OR) 1.04 per 1% increase, 95% confidence interval (CI) 1.01-1.09, p = 0.04], notching of baseline paced QRS in limb leads (OR 5.04, 95% CI 1.59-19.6, p = 0.005) and the QS pattern in all precordial leads (OR 3.56, 95% CI 1.21-10.8, p = 0.02) were independently associated with deterioration of LVEF. The QS pattern of baseline paced QRS in all precordial leads had 58% sensitivity, 93% specificity for the RV lead position at the tip of RV apex. In conclusion, considering OR by multivariate analysis, notching of baseline paced QRS in limb leads and the QS pattern in all precordial leads at device implantation may be simple and useful predictors to identify patients who are at risk for deterioration of cardiac function during long-term RVAP. 12-ECG monitoring at device implantation and avoidance of the RVAP site showing a QS pattern may be important to prevent deterioration of cardiac function in patients with frequent RVAP.

Cardiomyopathy Induced by Artificial Cardiac Pacing: To Whom, When, Why, and How? Insights on Heart Failure Development

“…Despite certain heterogeneity, a few variables were identified as predictors in more than one cohort, increasing reliability that these variables are true risk predictors - such is the case of RV pacing burden, discussed earlier. Among evaluated cohorts, RV pacing burden is listed a predictor in five of them ( Table 1 ) [ 6 , 13 , 14 , 19 , 50 ] . Importantly, all five studies are observational, the majority of which is retrospective.…”

Clinical Influence and Predictors of Pacing-Induced Mechanical Asynchrony in Patients with Normal Cardiac Function with Ventricular Lead Placed in Non-Apical Position

“…If the 12-lead electrocardiography results after pacemaker implantation revealed QS pattern in all precordial leads, we excluded the patients because the ventricular lead was located in the RV apex. 15) The estimated RV lead position was classified into 3 zones by In LAO view, the distal tip of the ventricular lead directed posteriorly indicates the septal position. 14) Additional RAO view was adopted to avoid placing the lead in the right ventricular apex, coronary sinus ostium, or the groove between the septum and anterior free wall.…”

“…We excluded patients with QS pattern in all precordial leads because the ventricular lead was estimated to be located in the right ventricular apex. 15) fluoroscopic images as reported previously: 16) 1) highseptum defined as one-third from the top of RV between the pulmonary artery bulge and the roof of the tricuspid valve, 2) mid-septum, and 3) low-septum defined as onethird from the bottom of RV.…”

Paced QRS morphology mimicking complete left bundle branch block induced by right ventricular pacing is associated with pacing‐induced cardiomyopathy

“…5 However, limited studies have elucidated the association between paced QRS morphology and PICM progression. 6,7 Since paced QRS morphology might be associated with ventricular dyssynchrony due to RV pacing, 8 specific paced QRS morphology could be related to PICM.…”