Post‐pacemaker implant QRS duration and heart failure admission in patients with sick sinus syndrome and complete atrioventricular block

Lee, Wei‐Chieh; Fang, Hsiu‐Yu; Chen, Huang‐Chung; Chen, Yung‐Lung; Tsai, Tzu‐Hsien; Pan, Kuo‐Li; Lin, Yu‐Sheng; Chen, Mien‐Cheng

doi:10.1002/ehf2.12445

Cited by 10 publications

(11 citation statements)

References 17 publications

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“…Moreover, the distribution of patients with right ventricular pacing > 40% was similar between patient with and without diabetes before and after PSM ( Table 1 ). Of note, patients with diabetes had a higher cumulative incidence of pacing-induced cardiomyopathy compared to patients without diabetes before and after PSM, consequently, more HF hospitalization in patients with diabetes, and these findings were consistent with our prior study [ 32 ]. Recently, conduction system pacing, such as His-bundle pacing and left bundle branch pacing, has been reported to reduce HF hospitalization compared to right ventricular pacing [ 33 , 34 ].…”

Section: Discussionsupporting

confidence: 92%

“…Many studies have shown that right ventricular pacing is associated with HF hospitalization [ 31 , 32 ]. Our prior study showed that right ventricular pacing QRS duration ≥ 163 milliseconds increased 3.5-fold risk of HF admission, and diabetes increased 2.7-fold risk of HF hospitalization [ 32 ]. Right ventricular pacing > 50% has been reported to be associated with an increased risk of HF hospitalization [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

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Diabetes Increases Risk of Cardiovascular Events in Patients Receiving Permanent Pacemaker: A Propensity Score-Matched Cohort Study

Chen

Liu

Tseng

et al. 2022

Journal of Diabetes Research

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Background. Type 2 diabetes was associated with a higher risk for permanent pacemaker (PPM) treatment. The difference in cardiovascular outcomes between patients with and without diabetes receiving PPM treatment remains unexplored. Method. Between January 2003 and December 2017, 1742 patients receiving naïve PPM treatment comprised this retrospective cohort study and were categorized into two groups by the diagnosis of diabetes: group with diabetes ( n = 632 , 36.3%) and group without diabetes ( n = 1110 , 63.7%). The primary outcome was cardiovascular events including heart failure (HF) hospitalization and acute myocardial infarction (AMI). The secondary outcomes of this study included pacemaker infection, pacing-induced cardiomyopathy, cerebrovascular accident, cardiovascular mortality, and all-cause mortality. Propensity score matching (PSM) was applied to reduce selection bias between the study groups. Result. During a mean follow-up period of 7.8 ± 4.8 years, 264 patients had a cardiovascular event. Before PSM, the incidence of cardiovascular events was higher in patients with diabetes compared to patients without diabetes (19.8% vs. 12.5%, P < 0.001 ), and the incidences of pacing-induced cardiomyopathy, cardiovascular mortality, and all-cause mortality were all higher in patients with diabetes compared to patients without diabetes. After PSM, the incidence of cardiovascular events was higher in patients with diabetes compared to patients without diabetes (18.8% vs. 12.3%, P = 0.015 ). The incidence of HF hospitalization was higher in patients with diabetes compared to patients without diabetes (15.3% vs. 10.2%, P = 0.037 ), whereas the incidence of AMI did not differ between the two groups. Moreover, after PSM, patients with diabetes had higher cumulative incidences of pacing-induced cardiomyopathy and all-cause mortality compared to patients without diabetes. Conclusions. The prevalence of diabetes was over one-third of naïve PPM recipients of this cohort, and diabetes increased the risk of cardiovascular events in PPM recipients, especially for HF hospitalization.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Diabetes Increases Risk of Cardiovascular Events in Patients Receiving Permanent Pacemaker: A Propensity Score-Matched Cohort Study

Chen

Liu

Tseng

et al. 2022

Journal of Diabetes Research

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“…Although it has been shown in some studies that a wider paced QRSd is an independent multivariable predictor for PICM development, this has not been confirmed in other research. [ 8 , 11 , 37 , 7 , 23 ] Its major limitation is that a conventional ECG visualises only the combined depolarisation of both ventricles and does not have the ability to assess their separate activation. [ 38 ] QRS morphology offers more insight into ventricular activation patterns; however, this assessment is subject to significant error.…”

Section: Risk Factors For Pacing-induced Cardiomyopathy and Dyssynchr...mentioning

confidence: 99%

Ventricular Dyssynchrony and Pacing-induced Cardiomyopathy in Patients with Pacemakers, the Utility of Ultra-high-frequency ECG and Other Dyssynchrony Assessment Tools

Mizner

Jurák

Línková

et al. 2022

Arrhythm Electrophysiol Rev

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The majority of patients tolerate right ventricular pacing well; however, some patients manifest signs of heart failure after pacemaker implantation and develop pacing-induced cardiomyopathy. This is a consequence of non-physiological ventricular activation bypassing the conduction system. Ventricular dyssynchrony was identified as one of the main factors responsible for pacing-induced cardiomyopathy development. Currently, methods that would allow rapid and reliable ventricular dyssynchrony assessment, ideally during the implant procedure, are lacking. Paced QRS duration is an imperfect marker of dyssynchrony, and methods based on body surface mapping, electrocardiographic imaging or echocardiography are laborious and time-consuming, and can be difficult to use during the implantation procedure. However, the ventricular activation sequence can be readily displayed from the chest leads using an ultra-high-frequency ECG. It can be performed during the implantation procedure to visualise ventricular depolarisation and resultant ventricular dyssynchrony during pacing. This information can assist the electrophysiologist in selecting a pacing location that avoids dyssynchronous ventricular activation.

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“…Meanwhile, some studies have shown that a longer QRS duration is associated with a higher risk of developing HF or PICM. 10 , 26 …”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Left Bundle Branch Area Pacing in Comparison with Right Ventricular Septal Pacing in Patients with High Ventricular Pacing Ratio ≥40%

Liu¹,

Li²,

Zhou³

et al. 2022

IJGM

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Background The aim of the present study is to compare the clinical outcomes between left bundle branch area pacing (LBBaP) and right ventricular septal pacing (RVSP) in patients with percent ventricular pacing (VP%) ≥40%. Methods Fifty-four patients with VP% ≥40% were retrospectively studied, including 33 patients with LBBaP and 21 patients with RVSP. QRS duration (QRSd), interventricular mechanical delay (IVMD) and septal-posterior wall motion delay (SPWMD) were measured to evaluate ventricular synchrony. Heart failure hospitalization (HFH), pacing parameters, and complications were evaluated postoperatively and at follow-ups. Results The mean follow-up duration of the study participants was 13.80 ± 4.47 months. In the LBBaP group, no significant differences were noted in paced QRSd, IVMD and SPWMD of the LBBaP capture and intrinsic-conduction modes, but the paced QRSd was narrower (QRSd, 110.88 ± 7.37 vs 132.90 ± 14.78 ms, P< 0.0001) and the IVMD and SPWMD were lower when compared with the RVSP group (IVMD, 28.16 ± 4.76 vs 40.28 ± 6.97 ms, P <0.0001; SPWMD, 43.68 ± 26.41 vs 97.94 ± 12.77 ms, P <0.0001). LBBaP was associated with better left ventricular function in comparison with RVSP during follow-ups (LVEDD, 47.09 ± 4.47 vs 51.28 ± 7.58, P = 0.017; LVEF, 64.81± 5.49 vs 60.44 ± 9.28, P = 0.041). Patients with LBBaP had lower occurrences of HFH than patients with RVSP (3.13% vs 27.78%, P = 0.034). Pacing parameters showed no differences between the two groups and remained stable throughout the study period. Conclusion The results of this study suggest that LBBaP may be more suitable for patients requiring long-term high ventricular pacing ratio.

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Post‐pacemaker implant QRS duration and heart failure admission in patients with sick sinus syndrome and complete atrioventricular block

Cited by 10 publications

References 17 publications

Diabetes Increases Risk of Cardiovascular Events in Patients Receiving Permanent Pacemaker: A Propensity Score-Matched Cohort Study

Diabetes Increases Risk of Cardiovascular Events in Patients Receiving Permanent Pacemaker: A Propensity Score-Matched Cohort Study

Ventricular Dyssynchrony and Pacing-induced Cardiomyopathy in Patients with Pacemakers, the Utility of Ultra-high-frequency ECG and Other Dyssynchrony Assessment Tools

Clinical Outcomes of Left Bundle Branch Area Pacing in Comparison with Right Ventricular Septal Pacing in Patients with High Ventricular Pacing Ratio ≥40%

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