Skip to main content
SpringerLink
Log in

Pacing-induced cardiomyopathy in patients with preserved ejection fraction undergoing permanent cardiac pacemaker placement

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

Chronic right-ventricular (RV) pacing can worsen heart failure in patients with a low ejection fraction (EF), but little is known about pacing-induced cardiomyopathy (PICM) in patients with preserved EF. We aimed to investigate risk factors of PICM in these patients during long-term follow-up.

Methods

The prospective registry at Chosun University Hospital, South Korea, included de novo patients with preserved EF undergoing transvenous permanent pacemaker (PPM) implantation for atrioventricular blockage from 2017 to 2021. Patients with EF ≥ 50% and expected ventricular pacing ≥ 40% were included. Composite outcomes were cardiac death (pump failure), hospitalization because of heart failure, PICM, and biventricular pacing (BVP) upgrade.

Results

A total of 168 patients (69 men, 76.3 ± 10.4 years) were included. During three years of follow-up, one patient died, 14 were hospitalized, 16 suffered PICM, and two underwent BVP upgrade. PICM were associated with reduced global longitudinal strain (GLS), prolonged paced QRS duration (pQRSd) and diastolic variables (E/e’, LAVI). Cox regression analysis identified pQRSd (hazard ratio [HR], 1.111; 95% confidence interval [CI], 1.011–1.222; P = 0.03) and reduced GLS (HR, 1.569; 95% CI, 1.163–2.118; P = 0.003) as independent predictors of PICM. GLS showed high predictive accuracy for PICM, with an area under the curve of 0.84 (95% CI 0.779–0.894; P < 0.001) [GLS –12.0, 62.5% sensitivity, and 86.1% specificity].

Conclusion

RV pacing increased the risk of PICM in patients with preserved EF. Reduced GLS and prolonged pQRSd could help identify individuals at high risk of PICM even with preserved EF.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

The datasets during the current study are available from the corresponding author on reasonable request.

References

  1. Furman S, Schwedel JB. An intracardiac pacemaker for Stokes-Adams seizures. N Engl J Med. 1959;261(19):943–8.

    Article  CAS  PubMed  Google Scholar 

  2. Tse H-F, Lau C-P. Long-term effect of right ventricular pacing on myocardial perfusion and function. J Am Coll Cardiol. 1997;29(4):744–9.

    Article  CAS  PubMed  Google Scholar 

  3. Wilkoff BL, Cook JR, Epstein AE, Greene HL, Hallstrom AP, Hsia H, et al. Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA. 2002;288(24):3115–23.

    Article  PubMed  Google Scholar 

  4. Sweeney MO, Hellkamp AS, Ellenbogen KA, Greenspon AJ, Freedman RA, Lee KL, et al. Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation. 2003;107(23):2932–7.

    Article  PubMed  Google Scholar 

  5. Funck RC, Mueller HH, Lunati M, Piorkowski C, De Roy L, Paul V, et al. Characteristics of a large sample of candidates for permanent ventricular pacing included in the biventricular pacing for atrio-ventricular block to prevent cardiac desynchronization Study (BioPace). Europace. 2014;16(3):354–62.

    Article  PubMed  Google Scholar 

  6. Slotwiner DJ, Raitt MH, Del-Carpio Munoz F, Mulpuru SK, Nasser N, Peterson PN. Impact of physiologic pacing versus right ventricular pacing among patients with left ventricular ejection fraction greater than 35%: a systematic review for the 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019;74(7):988–1008.

    Article  PubMed  Google Scholar 

  7. Khurshid S, Epstein AE, Verdino RJ, Lin D, Goldberg LR, Marchlinski FE, et al. Incidence and predictors of right ventricular pacing-induced cardiomyopathy. Heart Rhythm. 2014;11(9):1619–25.

    Article  PubMed  Google Scholar 

  8. Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016;29(4):277–314.

    Article  PubMed  Google Scholar 

  9. Karpawich PP, Justice CD, Cavitt DL, Chang C-H. Developmental sequelae of fixed-rate ventricular pacing in the immature canine heart: an electrophysiologic, hemodynamic, and histopathologic evaluation. Am Heart J. 1990;119(5):1077–83.

    Article  CAS  PubMed  Google Scholar 

  10. Kim JH, Kang KW, Chin JY, Kim TS, Park JH, Choi YJ. Major determinant of the occurrence of pacing-induced cardiomyopathy in complete atrioventricular block: a multicentre, retrospective analysis over a 15-year period in South Korea. BMJ open. 2018;8(2):e019048.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Khurshid S, Liang JJ, Owens A, Lin D, Schaller R, Epstein AE, et al. Longer paced qrs duration is associated with increased prevalence of right ventricular pacing-induced cardiomyopathy. J Cardiovasc Electrophysiol. 2016;27(10):1174–9.

    Article  PubMed  Google Scholar 

  12. Chen S, Yin Y, Lan X, Liu Z, Ling Z, Su L, et al. Paced QRS duration as a predictor for clinical heart failure events during right ventricular apical pacing in patients with idiopathic complete atrioventricular block: results from an observational cohort study (PREDICT-HF). Eur J Heart Fail. 2013;15(3):352–9.

    Article  PubMed  Google Scholar 

  13. Miyoshi F, Kobayashi Y, Itou H, Onuki T, Matsuyama T, Watanabe N, et al. Prolonged paced QRS duration as a predictor for congestive heart failure in patients with right ventricular apical pacing. Pacing Clin Electrophysiol. 2005;28(11):1182–8.

    Article  PubMed  Google Scholar 

  14. Smiseth OA, Torp H, Opdahl A, Haugaa KH, Urheim S. Myocardial strain imaging: how useful is it in clinical decision making? Eur Heart J. 2016;37(15):1196–207.

    Article  PubMed  Google Scholar 

  15. Ahmed FZ, Motwani M, Cunnington C, Kwok CS, Fullwood C, Oceandy D, et al. One-month global longitudinal strain identifies patients who will develop pacing-induced left ventricular dysfunction over time: the pacing and ventricular dysfunction (PAVD) study. PLoS One. 2017;12(1):e0162072.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Walmsley J, Huntjens PR, Prinzen FW, Delhaas T, Lumens J. Septal flash and septal rebound stretch have different underlying mechanisms. Am J Physiol Heart Circ Physiol. 2016;310(3):H394–403.

    Article  PubMed  Google Scholar 

  17. Abdelrahman M, Subzposh FA, Beer D, Durr B, Naperkowski A, Sun H, et al. Clinical outcomes of his bundle pacing compared to right ventricular pacing. J Am Coll Cardiol. 2018;71(20):2319–30.

    Article  PubMed  Google Scholar 

  18. Vijayaraman P, Herweg B, Dandamudi G, Mittal S, Bhatt AG, Marcantoni L, et al. Outcomes of His-bundle pacing upgrade after long-term right ventricular pacing and/or pacing-induced cardiomyopathy: Insights into disease progression. Heart Rhythm. 2019;16(10):1554–61.

    Article  PubMed  Google Scholar 

  19. Vijayaraman P, Herweg B, Verma A, Sharma PS, Batul SA, Ponnusamy SS, et al. Rescue left bundle branch area pacing in coronary venous lead failure or nonresponse to biventricular pacing: results from International LBBAP Collaborative Study Group. Heart Rhythm. 2022;19(8):1272–80.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank Ji Myung Lee (GE Ultrasound Korea) for acquiring and analyzing the echocardiographic data.

Funding

This study was supported by research funds from the Chosun University, 2023.

Author information

Authors and Affiliations

  1. Department of Cardiovascular Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea

    Jae Yeong Cho

  2. Department of Cardiovascular Medicine, Chosun University Medical School, Gwangju, South Korea

    Sung Soo Kim, In Young Choi, Hyun Kuk Kim, Young Jae Ki, Dong Hyun Choi & Keun Ho Park

  3. Department of Cardiovascular Medicine, Won Kwang University Medical School, Iksan, South Korea

    Hyung Ki Jeong

Authors
  1. Jae Yeong Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sung Soo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hyung Ki Jeong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. In Young Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hyun Kuk Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Young Jae Ki
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dong Hyun Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Keun Ho Park
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sung Soo Kim.

Ethics declarations

Ethics approval

This study was approved by the Institutional Review Board of the Chosun University Hospital (CHOSUN 2023-03-012).

Patient consent statement

All patients provided informed consent.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cho, J.Y., Kim, S.S., Jeong, H.K. et al. Pacing-induced cardiomyopathy in patients with preserved ejection fraction undergoing permanent cardiac pacemaker placement. J Interv Card Electrophysiol 67, 363–369 (2024). https://doi.org/10.1007/s10840-023-01650-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-023-01650-5

Keywords

Search

Navigation