Survival of patients with pacing‐induced cardiomyopathy upgraded to CRT does not depend on defibrillation therapy

Abstract

Background: Permanent right ventricular pacing (RVP) results in cardiac dyssynchrony that may lead to heart failure and may be an indication for the use of cardiac resynchronization therapy (CRT). The study aimed to evaluate predictors of outcomes in patients with pacing-induced cardiomyopathy (PICM) if upgraded to CRT. Methods: One hundred fifteen patients, 75.0 years old (IQR 67.0-80.0), were upgraded to CRT due to the decline in left ventricle ejection fraction (LVEF) caused by the long-term RVP. A retrospective analysis was performed using data from hospital and outpatient clinic records and survival data from the National Health System. Results: The prior percentage of RVP was 100.0% (IQR 97.0-100.0), with a QRS duration of 180.0 ms (IQR 160.0-200.0). LVEF at the time of the upgrade procedure was 27.0% (IQR 21.0-32.75). The mean follow-up was 980 ± 522 days. The primary endpoint, death from any cause, was met by 26 (22%) patients. Age > 82 years (HR 5.96; 95% CI 2.24-15.89; P = .0004) and pre-CRT implantation LVEF < 20% (HR 5.63; 95%CI 2.19-14.47; P = .0003), but neither the cardioverterdefibrillator (ICD) implantation (HR 1.00; 95%CI 0.45-2.22; P = 1.00), nor the presence of atrial fibrillation (HR 1.22; 95%CI 0.56-2.64; P = .62), were independently associated with all-cause mortality. Conclusion: Advanced age and an extremely low LVEF, but neither the presence of atrial fibrillation nor implanting an additional high voltage lead, influence the all-cause mortality in patients after long-term RVP, when upgraded to CRT. K E Y W O R D S cardiac resynchronization therapy upgrade, chronic right ventricular pacing, defibrillator, pacinginduced cardiomyopathy

Sex‐based differences in cardiac resynchronization therapy upgrade and outcome for patients with pacemaker and new‐onset heart failure

“…In general, adding a defibrillator in older patients with limited life expectancy does not necessarily lead to a survival benefit, whereas successful CRT treatment improves quality of life and reduces heart failure hospitalizations. Furthermore, with successful CRT in this group of patients, LVEF often improves to above 35% which is the accepted threshold for primary preventive ICD treatment 20,21 . The choice of device may however also be influenced by the presence of ischemic heart disease, since ischemic disease portends a higher risk of ventricular arrhythmias as well as worse overall survival (as shown both in our cohort and by others).…”

“…Furthermore, with successful CRT in this group of patients, LVEF often improves to above 35% which is the accepted threshold for primary preventive ICD treatment. 20,21 The choice of device may however also be influenced by the presence of ischemic heart disease, since ischemic disease portends a higher risk of ventricular arrhythmias as well as worse overall survival (as shown both in our cohort and by others). Regardless of this, one of the main findings of the present study is that there is still a significant underutilization of CRT in both men and women, and increased awareness of CRT as a treatment alternative in this group of patients is important.…”

The Effects of His Bundle Pacing Compared to Classic Resynchronization Therapy in Patients with Pacing-Induced Cardiomyopathy

“…During FU, we found possibly a proarrhythmic effect of BVP in only one patient with BVP and no previous ventricular arrhythmia history of recurrent VT [ 16 ]. Considering the high probability of LVEF improvement over 35% and the recently reported lack of influence of ICD therapy on all-cause mortality in patients upgraded to CRT after long-lasting RVP [ 4 ], ICD therapy should be carefully considered at the time of upgrade.…”

“…The study included a prospective, observational analysis of patients hospitalized in the Department of Electrocardiology at Professor Leszek Giec Upper-Silesian Medical Centre of the Medical University of Silesia in Katowice, Poland, with chronic RVP and heart failure symptoms considered to be caused by PICM. PICM was defined as worsening congestive heart failure accompanied by a decline in the left ventricular ejection fraction (LVEF) below 50% with an RVP burden of equal to or over 40% [ 4 ]. Patients’ medical records were carefully checked with alternative causes of LV function decline, such as myocardial infarction, valvular heart disease, frequent (20%) premature ventricular depolarizations, and atrial arrhythmias with rapid ventricular response, and when it was the case, they were excluded.…”

The usefulness of His bundle pacing in a heterogeneous population of patients with impaired left ventricular systolic function

“…IVCD was defined according to American College of Cardiology/American Heart Association (ACC/AHA) recommendations [9]. PICM was defined as congestive HF worsening accompanied by a decline in LVEF < 50% with a right ventricle (RV) pacing burden of ≥ 40% [10]. The positive hemodynamic response in responders to synchronic HBP stimulation was defined a reduction ≥15% in indexed LV end-systolic volume (LVESVi).…”