Incidence and predictors of right ventricular pacing-induced cardiomyopathy in patients with complete atrioventricular block and preserved left ventricular systolic function

Kiehl, Erich L.; Makki, Tarek; Kumar, Rahul; Gumber, Divya; Kwon, Deborah; Rickard, John; Kanj, Mohamed; Wazni, Oussama; Saliba, Walid; Varma, Niraj; Cantillon, Daniel J.

doi:10.1016/j.hrthm.2016.09.027

Cited by 302 publications

(272 citation statements)

References 27 publications

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“…[5][6][7] However, the mechanisms of PICM remain controversial because only a small subset of patients exposed to frequent RV pacing develop PICM. 8 Others reported that patients with a pacing QRS duration ≥150 ms should be screened using echocardiography to assess for PICM if the RV pacing percentage is >20%. 8 Others reported that patients with a pacing QRS duration ≥150 ms should be screened using echocardiography to assess for PICM if the RV pacing percentage is >20%.…”

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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“…If the restoration of the sinus rhythm is no longer possible there are still three options of a right ventricular, bi-ventricular and direct His-bundle pacing. The right ventricular pacing can be life-saving but in the long term it can also contribute to the so-called pacing cardiomyopathy in a substantial part of paced patients [8]. The bi-ventricular pacing, better known as cardiac resynchronization therapy, was introduced to correct the left bundle branch block--related dyssynchrony and could of course be considered in the presented patient according to the Guidelines [2].…”

Section: Discussionmentioning

confidence: 99%

Optymalna rozbudowa dwujamowego układu stymulującego u pacjentki z utrwalonym migotaniem przedsionków

et al. 2017

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In patients with sick sinus syndrome, and previously implanted dual-chamber pacemaker, the occurrence of atrial fibrillation finally assessed as permanent is most commonly regarded as a natural course of the disease. The inappropriate heart rate control and right ventricular pacing can both negatively influence left ventricle mechanical performance leading to cardiomyopathy and heart failure.It was presented the case of a 72-year-old woman with permanent atrial fibrillation with narrow QRS complex, after dual-chamber pacemaker implantation, admitted to our department with signs and symptoms of acute decompensated congestive heart failure. The modification of pharmacotherapy allowed to compensate heart failure, however with only small influence on structural remodelling and patient's symptoms. The successful upgrade of the pacing system to the direct His-bundle pacing enabled the restoration of proper function of the heart and full symptoms relief. The direct His-bundle pacing is an approach of choice in such a group of patients.

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“…During the final eight years of follow-up, however, a high RV pacing percentage was associated with a 40% increase in the risk of death in comparison with the rate associated with low RV pacing. 8,9 A more recent retrospective analysis of 823 consecutive patients undergoing permanent pacemaker (PPM) implantation between 2000 and 2014 for complete heart block with LV ejection fraction (LVEF) > 50% was performed by Kiehl et al 10 Pacing-induced cardiomyopathy (PICM), defined as a cardiac resynchronization therapy (CRT) upgrade or post-PPM LVEF ≤ 40%, occurred in 101 (12.3%) patients over the mean follow-up period of 4.3 years ± 3.9 years. RV lead position was distributed relatively evenly between apical and nonapical positions.…”

Section: Introductionmentioning

confidence: 99%

“…In multivariable analysis, lower pre-PPM LVEF and RV pacing percentage (> 20%) were independently associated with PICM. 10 …”

Section: Introductionmentioning

confidence: 99%

Right Ventricular Septal Pacing: A Paradigm Shift

Worsnick

Sharma

Vijayaraman

2018

J Innov Cardiac Rhythm Manage

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Several studies conducted in the past 10 years have demonstrated the adverse effects of conventional RVA pacing. The Mode Selection Trial (MOST) study included a total of 2,010 patients with sick sinus syndrome who underwent dual-chamber pacemaker implants that were programmed to either a DDD or VVI mode. At three years following implantation, HF hospitalizations were found to have occurred in 12.3% of the VVI group and 10.3% of the DDD group. Of these, 50% were due to new-onset HF. Patients with a greater than 40% ventricular pacing rate in the DDD group and those with a more than 80% pacing rate in the VVI group had a twofold risk of heart failure events [DDD adjusted hazard ratio (HR): 2.60, 95% confidence interval (CI): 1.05-6.47; p < 0.05 and VVI HR: 2.50, 95% CI: 1.44-4.36; p < 0.05]. The similar increase in HF events in patients with both DDD and VVI pacing modes suggests that RVA pacing was independently associated with higher HF events, regardless of atrioventricular (AV) synchrony. 5 A substudy of the MOST trial further demonstrated that the

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Incidence and predictors of right ventricular pacing-induced cardiomyopathy in patients with complete atrioventricular block and preserved left ventricular systolic function

Abstract: PICM is not uncommon in patients receiving PPM for CHB with preserved LVEF and is strongly associated with RV pacing burden >20%. CRT response rate is high in PICM, but is perhaps underutilized.

Cited by 302 publications

References 27 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

Optymalna rozbudowa dwujamowego układu stymulującego u pacjentki z utrwalonym migotaniem przedsionków

Right Ventricular Septal Pacing: A Paradigm Shift

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