Pacemaker dependency after implantation of electrophysiological devices

Abstract

Pacemaker dependency is observed in an appreciable number of chronically paced patients. Although there is no standard definition, pacemaker dependency has a significant impact on the management of patients in several clinical settings. In this review, we provide a comprehensive overview of the available data regarding definition, testing, clinical significance, epidemiology, and mechanisms of pacemaker dependency. Several issues regarding the underlying pathophysiology remain obscure and the potential value of interventions that may alter its incidence, clinical course, and consequences remains to be elucidated.

Electrocardiographic Predictors of Long‐Term Cardiac Pacing Dependency Following Transcatheter Aortic Valve Implantation

“…Based on previously published data, long‐term pacemaker dependency was defined as: Absent or inadequate intrinsic ventricular rhythm on pacemaker interrogation (An intrinsic rhythm of less than 30 beats per minute). More than 5% of ventricular pacing from the last follow‐up on pacemaker interrogation. Any evidence of ventricular pacing on pacemaker interrogation in cases where the programmed atrioventricular interval (AVI) was more than 300 milliseconds. …”

Management of radiation oncology patients with a pacemaker or ICD: A new comprehensive practical guideline in The Netherlands

“…Depending on the intrinsic heart rhythm of the patient and the setting of the pacemaker function, pacing by the pacemaker or ICD may occur occasionally or continuously. In a mixed population, around 10% (range: 2-63%) of patients are so-called pacing dependent, meaning they have no intrinsic or escape rhythm and may become symptomatic (syncope, arrhythmia, serious injury or even sudden death) when the CIED pacing function fails [41-43]. It is obvious that a complete loss of pacing ability will have major implications for pacing dependent patients.…”

Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG‐203†

“…A commonly used clinical definition of when pacing is dependent is when patients have an inadequate or absent intrinsic heart rhythm, which turns symptomatic in case of a (sudden) failure of the CIED’s pacing function. Symptoms can vary, but may include acute syncope, heart failure, arrhythmia, and can lead to death . The incidence of pacing dependency is roughly 10%.…”