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

Abstract

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.

Leadless vs. transvenous single-chamber ventricular pacing in the Micra CED study: 2-year follow-up

“…13–15 Sanchez and colleagues recently reported a substantially lower rate of pacemaker-induced cardiomyopathy among a single-centre cohort of pacemaker-dependent patients receiving leadless VVI devices (3%) compared to those receiving transvenous pacemakers (13.7%). 16 Whether rates of device system revision in longer-term follow-up are different between leadless and transvenous VVI pacemakers is an important clinical question. After adjustment for baseline clinical risk, leadless VVI pacemakers were associated with a 38% lower rate of reintervention at 2 years.…”

Tricuspid regurgitation in His bundle pacing: A systematic review

“…Regarding causation, it is difficult to disentangle the role of mechanical disruption of tricuspid valve by pacemaker leads from pacing induced dyssynchrony, but it is plausible that both contribute. (Cheema et al, 2021 ; Khurshid et al, 2014 ; Lamas et al, 2000 ; Mandras & Desai, 2021 ; Matusik et al, 2010 ; Sanchez et al, 2021 ).…”

Proposed strategies to overcome venous occlusion in the implantation of a cardiac implantable electronic device: A case report and literature review

“…It was also shown that leadless pacemaker therapy resulted in worsening biventricular function and mitral regurgitation and had an equivalent rate of deterioration in tricuspid regurgitation compared to a transvenous pacemaker ( 15 ). Although one study including 198 patients with 100% right ventricular pacing reported a 3 vs. 14% incidence of pacing-induced cardiomyopathy (PICM) in leadless and transvenous pacemaker groups, larger studies are required to confirm the stated lower incidence of PICM in patients with leadless pacemakers ( 16 ). Surgical epicardial lead implantation or endocardial lead placement via trans-atrial access should be the last resort due to invasiveness.…”