Incidence and predictors of pacemaker-induced cardiomyopathy with comparison between apical and non-apical right ventricular pacing sites

Bansal, Raghav; Parakh, Neeraj; Gupta, Anunay; Juneja, Rajnish; Naik, Nitish; Yadav, Rakesh Kumar; Sharma, Gautam; Roy, Ambuj; Verma, Sunil Kumar; Bahl, Vinay K.

doi:10.1007/s10840-019-00602-2

Cited by 39 publications

(68 citation statements)

References 22 publications

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“…Two older studies found an association of apical pacing and PICM 11,15 . A recent study did not find any association of lead location on the incidence of PICM; however, this study had a relatively shorter follow‐up of 14 months compared with a previous study of similar size with discordant results 5 …”

Section: Discussioncontrasting

confidence: 54%

“…This study did not show any significant reduction of QRS duration with septal pacing with LP. A recent study also suggested that interventricular dyssynchrony (aortopulmonary ejection delay: >40 ms) was a predictor of PICM in patients with TVP 5 . It is likely that interventricular dyssynchrony is less pronounced with septal pacing; however, this study did look at this aspect.…”

Section: Discussionmentioning

confidence: 81%

“…Some previous studies have suggested that the duration of native QRS and paced QRS may impact the development of PICM 5 . Due to preferential implantation of LP in the septal location, it was conceivable that the duration of paced QRS in patients with LP may be shorter than TVP as seen in previous studies 16 .…”

Section: Discussionmentioning

confidence: 86%

“…It is conceivable that a larger study with more patients with PICM in the LP cohort may delineate the real impact of implant location for the development of PICM. Multiple previous studies have looked at the impact of apical versus septal pacing for the development of PICM 5,11,15 . Two older studies found an association of apical pacing and PICM 11,15 .…”

Section: Discussionmentioning

confidence: 99%

“…Certain clinical predictors for PICM have been identified and include wide QRS duration at baseline, RV pacing burden, and reduced ventricular function before pacemaker implantation. Some studies have suggested a role of tricuspid regurgitation (TR) and apical location of pacing lead in the RV as contributory to the development of PICM; however, the data are discordant 5,6 . Incidence of PICM has not been reported for LP.…”

Section: Introductionmentioning

confidence: 99%

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Incidence of pacing‐induced cardiomyopathy in pacemaker‐dependent patients is lower with leadless pacemakers compared to transvenous pacemakers

Sanchez

Nadkarni

Buck

et al. 2020

Cardiovasc electrophysiol

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Introduction Frequent right AQ4ventricular pacing (≥40%) with a transvenous pacemaker (TVP) is associated with the risk of pacing‐induced cardiomyopathy (PICM). Leadless pacemakers (LPs) have distinct physical and mechanical differences from TVP. The risk of PICM with LP is not known. To identify incidence, predictors, and long‐term outcomes of PICM in LP and TVP patients. Methods The study comprised all pacemaker‐dependent patients with LP or TVP who had left ventricular ejection fraction (LVEF) of ≥50 from 2014 to 2019. The incidence of PICM (≥10% LVEF drop) was assessed with an echocardiogram. Predictors for PICM were identified using multivariate analysis. Long‐term outcomes after cardiac resynchronization (CRT) were assessed in both groups. Results A total of 131 patients with TVP and 67 with LP comprised the study. All patients in the TVP group and the majority in the LP group underwent atrioventricular node ablation. The mean follow‐up duration in TVP and LP groups was 592 ± 549 and 817 ± 600 days, respectively. A total of 18 (13.7%) patients in TVP and 2 (3%) in LP developed PICM after a median duration of 254 (interquartile range: 470) days. The incidence of PICM was significantly higher with TVP compared with LP (p = .02). TVP as pacing modality was a positive (odds ratio [OR]: 1.07) while age was negative (OR: 0.94) predictor for PICM on multivariable analysis. Both patients in LP and all except two in the TVP group responded to CRT. Conclusion Incidence of PICM is significantly lower with LP compared with TVP in pacemaker‐dependent patients. Age and TVP as pacing modality were predictors for PICM.

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Section: Discussioncontrasting

confidence: 54%

Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Incidence of pacing‐induced cardiomyopathy in pacemaker‐dependent patients is lower with leadless pacemakers compared to transvenous pacemakers

Sanchez

Nadkarni

Buck

et al. 2020

Cardiovasc electrophysiol

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Clinical outcomes of left bundle branch pacing compared to right ventricular apical pacing in patients with atrioventricular block

Zhang

Guo

Tao

et al. 2021

Clinical Cardiology

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Background Left bundle branch pacing (LBBP) can produce near normalization of QRS duration. This has recently emerged as alternative technique to right ventricular pacing and His bundle pacing. Hypothesis The purpose of this study is to evaluate clinical outcomes of LBBP compared to right ventricular apical pacing (RVAP). Methods A total of 70 AVB patients with indications for ventricular pacing were retrospectively studied. LBBP was attempted in 33 patients, classified as LBBP group. The other patients were classified as RVAP group. Pacing parameters, electrocardiogram and echocardiogram characteristics, heart failure hospitalization (HFH), and atrial fibrillation (AF) were evaluated perioperatively and at follow‐ups. Patients were followed in the device clinic for a minimum of 12 months and up to 24 months at a 3–6 monthly interval. Results LBBP was successful in 29 of 33(87.9%) patients while all 37 of the remaining patients successfully underwent RVAP. Paced QRS duration was significantly narrower in the LBBP group compare to RVAP(110.75 ± 6.77 ms vs. 154.29 ± 6.96 ms, p = .000) at implantation, and the difference persisted during follow‐ups. Pacing thresholds (at implantation: 0.68 ± 0.22 V in the LBBP group and 0.73 ± 0.23 V in the RVAP group, p = .620) remained low and stable during follow‐ups. The cardiac function in the LBBP group remained stable during follow‐ups (LVEF%:55.08 ± 4.32 pre‐operation and 54.17 ± 4.34 at the end of follow‐up, p = .609), and better than RVAP group (LVEF%: 54.17 ± 4.34 vs. 50.14 ± 2.14, p = .005). Less HFH was observed in the LBBP group (2/29,6.89%) compared to RVAP group (10/37,27.03%). Conclusions The present investigation demonstrates the safety and feasibility of LBBP that produces narrower paced QRS duration than RVAP. LBBP is associated with reduction in the occurrence of pacing‐induced left ventricular dysfunction and HFH compared to RVAP in patients requiring permanent pacemakers.

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Left bundle branch pacing: An evolving site for physiological pacing

Mulia

Amadis

Julario

et al. 2021

Journal of Arrhythmia

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For patients with symptomatic bradyarrhythmia, cardiac pacing is the only appropriate treatment option. Electrical and mechanical dyssynchrony caused by traditional right ventricular apical pacing leads to left ventricular dysfunction and atrial arrhythmias. Physiological pacing stimulates natural cardiac conduction, resulting in synchronized ventricular contraction. Even if His bundle pacing (HBP) is an ideal physiological pacing modality, it is technically not always feasible because of high capture thresholds, disease in the distal His bundle, and follow-up troubleshooting issues. Left bundle branch pacing (LBBP) has been proposed as a viable alternative to HBP since it provides lead stability, a low and stable pacing threshold, and correction of distal conduction system disease.

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Incidence and predictors of pacemaker-induced cardiomyopathy with comparison between apical and non-apical right ventricular pacing sites

Cited by 39 publications

References 22 publications

Incidence of pacing‐induced cardiomyopathy in pacemaker‐dependent patients is lower with leadless pacemakers compared to transvenous pacemakers

Incidence of pacing‐induced cardiomyopathy in pacemaker‐dependent patients is lower with leadless pacemakers compared to transvenous pacemakers

Clinical outcomes of left bundle branch pacing compared to right ventricular apical pacing in patients with atrioventricular block

Left bundle branch pacing: An evolving site for physiological pacing

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