Incidence and predictors of right ventricular pacing-induced cardiomyopathy

Khurshid, Shaan; Epstein, Andrew E.; Verdino, Ralph J.; Lin, David; Goldberg, Lee R.; Marchlinski, Francis E.; Frankel, David S.

doi:10.1016/j.hrthm.2014.05.040

Cited by 298 publications

(383 citation statements)

References 19 publications

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“…21 In a single-center study of 257 patients with normal baseline LVEF, PICM (defined as a drop in LVEF of ≥10% from baseline) developed in 20% of patients with an RV pacing burden of ≥20% at a mean follow-up of 3.3 years. 11 In the MOST (Mode Selection Trial), among a cohort of individuals with normal LVEF and little to no HF symptoms at baseline who underwent pacemaker implantation for sinus node dysfunction, a first HF hospitalization was nearly 3-fold more likely among those with >40% RV pacing compared with those with ≤40% pacing burden during a median follow-up of 33.1 months. 8 Moreover, by 48 months post-pacemaker implantation, ≈15% of individuals in the high-burden RV pacing group had experienced a HF hospitalization.…”

Section: Discussionmentioning

confidence: 99%

“…3,10 A few studies have looked at the incidence of HF events (primarily HF hospitalization) as a function of RV pacing burden among individuals with normal baseline LVEF, but most of these studies have been relatively small and, therefore, unable to clearly define the time course with which HF develops in the setting of RV pacing. [7][8][9]11,12 In this large retrospective study using real-world data, we sought to characterize the incidence and time course of newonset HF in the setting of atrioventricular disease and anticipated high-burden RV pacing. We also investigated the effect of baseline demographics and comorbidities on HF development after pacemaker implantation.…”

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confidence: 99%

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Incidence and Time Course for Developing Heart Failure With High-Burden Right Ventricular Pacing

Merchant

Hoskins

Musat

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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Background-Although right ventricular pacing can contribute to cardiomyopathy, the impact of complete atrioventricular block (cAVB) on heart failure (HF) development in pacemaker patients has not been well characterized. We evaluated the incidence and time course for developing HF after pacemaker implantation for cAVB. Methods and Results-A MarketScan database identified patients undergoing dual-chamber pacemaker implantation from 2008 to 2014. Patients with cAVB were identified by an atrioventricular node ablation or diagnosis of third-degree AVB.Patients with ≥1 year of continuous MarketScan enrollment before and after implant and without a previous diagnosis of HF were dichotomized into those with cAVB and without AVB. The primary end point was new HF assessed over acute (0-6 months) and chronic (6 months to 4 years) phases post-pacemaker implantation. The cohort included 6994 cAVB patients and 14 208 patients without AVB, followed for 2.35 years (interquartile range, 1.62-3.39 years). After adjustment for baseline covariates, patients with cAVB experienced an increased risk of new-onset HF in the acute phase (hazard ratio, 1.62; 95% confidence interval, 1.48-1.79; P<0.001). Although the risk of HF remained elevated among those with cAVB in the chronic phase, the effect was attenuated (hazard ratio, 1.16; 95% confidence interval, 1.08-1.25; P<0.001). After pacemaker implantation, younger patients (≤55 years of age) and those with an antecedent history of atrial fibrillation experienced the highest risk of HF associated with cAVB. Conclusions-Patients with a diagnosis of cAVB, and thus presumed to have a higher burden of right ventricular pacing, experienced an increased risk of new-onset HF after pacemaker implantation compared with those without AVB. Better tools are needed to identify patients at high risk of developing HF in the setting of right ventricular pacing and to determine whether these patients benefit from upfront biventricular pacing. Study PopulationPatients were selected for study inclusion if they were implanted with a de novo dual-chamber pacemaker (Current Procedural Terminology code 33208 and Healthcare Common Procedure Coding System codes C1785 and C2619) from any manufacturer between April 1, 2008, and March 31, 2014. Patients with a left ventricular lead placed (Current Procedural Terminology codes 33224 or 33225) at the time of pacemaker implantation were excluded. De novo implants were identified as pacemaker patients without a previous device implantation and without a remote or in-office pacemaker follow-up visit in the 1 year before implantation. An enrollment indicator confirmed active inclusion in the MarketScan databases for each patient per month. Patients were required to have at least 1 year of continuous enrollment in the MarketScan database before and after pacemaker implantation and to be ≥18 and ≤100 years of age at the time of pacemaker implantation.To evaluate the impact of atrioventricular block (AVB) on the development of HF after pacemaker implantation, patients wi...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Incidence and Time Course for Developing Heart Failure With High-Burden Right Ventricular Pacing

Merchant

Hoskins

Musat

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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“…Khurshid et al reported that CRT was appropriate for the prevention of PMinduced cardiomyopathy in a wide native QRS duration (>115 ms) irrespective of reduced LVEF. 10) However, even Numata, ET AL in the lacking of wide QRS or reduced EF, RV pacing is presumed to alter geometry and function of the vulnerable LV through electrical and mechanical dysynchrony, and an increase LV end diastolic volume, leading to the LV systolic dysfunction. 3) In patients with Ebstein's anomaly, these deteriorating effects of RV pacing on cardiac function might be enhanced and result in marked depression of LVEF even if they have preserved LVEF.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Resynchronization Therapy in Patients with Ebstein's Anomaly

et al. 2017

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SummaryEbstein's anomaly is a rare congenital heart disease characterized by apical displacement of the septal and posterior tricuspid valve leaflets. It is often complicated with left ventricular (LV) dysfunction as well as rightsided abnormalities. On the other hand, in the presence of LV dysfunction, right ventricular pacing is likely to aggravate the diseased LV function, which is termed pacemaker-induced cardiomyopathy. Thus, deteriorating effects of RV pacing on cardiac function might be enhanced and result in pacemaker-induced cardiomyopathy in patients with Ebstein's anomaly, even if they have preserved LVEF. Cardiac resynchronization therapy (CRT) is effective for the treatment of pacemaker-induced cardiomyopathy, and we present the first case of effect of CRT on pacemaker-induced cardiomyopathy associated with Ebstein's anomaly. (Int Heart J 2017; 58: 816-819)

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“…A growing body of evidence shows that right ventricular (RV) pacing has a detrimental effect on left ventricular (LV) function and remodeling despite normal ejection fraction before implantation. Both pacing-induced cardiomyopathy 7 and new-onset of HF 8 are frequently encountered in patients undergoing RV pacing, even in those with less than 40 % accumulative pacing and in the shortterm (less than one month) pacing. Despite satisfactory response to CRT upgrading in patients with RV pacing-induced LV remodeling or HF, 9 this is a "wait-and-see" approach, especially for outpatients with infrequent echocardiographic examination.…”

Section: Preventive Role Of Cardiac Resynchronisation Therapy In Hearmentioning

confidence: 99%

Cardiac Resynchronisation Therapy and Heart Failure: Persepctive from 5P Medicine

Fang¹,

Jie²,

Luo³

et al. 2015

Cardiac Failure Review

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Chronic heart failure is still a major challenge for healthcare. Currently, cardiac resynchronisation therapy (CRT) has been incorporated into the updated guideline for patients with heart failure, left ventricular ejection fraction ≤35 % and prolonged QRS duration. With 20 years of development, the concept of ‘from bench to bedside’ has been illustrated in the field of CRT. Given the fact that the indications of CRT keep evolving, the role of CRT is not limited to the curative method for heart failure. We therefore summarise with the perspective of 5P medicine – preventive, personalised, predictive, participatory, promotive, to review the benefit of CRT in the prevention of heart failure in those with conventional pacemaker indications, the individualised assessment of patient’s selection, the predictor of responders of CRT, and the obstacles hindering the more application of CRT and the future development of this device therapy.

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Incidence and predictors of right ventricular pacing-induced cardiomyopathy

Cited by 298 publications

References 19 publications

Incidence and Time Course for Developing Heart Failure With High-Burden Right Ventricular Pacing

Incidence and Time Course for Developing Heart Failure With High-Burden Right Ventricular Pacing

Cardiac Resynchronization Therapy in Patients with Ebstein's Anomaly

Cardiac Resynchronisation Therapy and Heart Failure: Persepctive from 5P Medicine

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