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Pacing-induced cardiomyopathy: pathophysiological insights through matrix metalloproteinases

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Abstract

Pacing-induced ventricular dysfunction and pacing-induced cardiomyopathy (PiCMP) are recognized complications of chronic right ventricular pacing. Alterations in myocardial perfusion and sympathetic innervation contribute to the development of pacing-induced heart disease. However, it is unlikely that these are the only processes involved. Matrix metalloproteinases (MMPs) are proteolytic enzymes that degrade the collagenous extracellular matrix and play a central role in left ventricular remodelling during the development of heart failure. While the pathophysiological mechanisms and altered MMP expression that occur in chronic pressure overload, ischaemic and non-ischaemic dilated cardiomyopathy have been defined, those that occur in the clinical setting of pacing-induced ventricular dysfunction and PiCMP have not been reported. Here we review the clinical epidemiology of pacing-induced ventricular dysfunction and discuss how data derived from animal models provide insight into how changes in MMP expression and function contribute to the development of PiCMP. The review concludes by exploring pacing strategies that may be used to prevent pacing-induced ventricular dysfunction.

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Acknowledgments

F.A. is supported by a research grant funded by Medtronic.

Conflict of interest

F.A. has received sponsorship from Boston Scientific to attend educational meetings. F.A. and A.Z. have received research funding and sponsorship to attend educational meetings from Medtronic. R.S.K., L.N., D.O. and M.M. have no competing interests to declare.

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Authors and Affiliations

  1. Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK

    Fozia Z. Ahmed, Amir M. Zaidi, Ludwig Neyses & Mamas Mamas

  2. Cardiovascular Institute, University of Manchester, Oxford Road, Manchester, M13 9WL, UK

    Fozia Z. Ahmed, Ludwig Neyses, Delvac Oceandy & Mamas Mamas

  3. Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK

    Rajdeep S. Khattar

  4. National Heart and Lung Institute, Imperial College, London, UK

    Rajdeep S. Khattar

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  1. Fozia Z. Ahmed
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  2. Rajdeep S. Khattar
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  3. Amir M. Zaidi
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  4. Ludwig Neyses
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  5. Delvac Oceandy
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  6. Mamas Mamas
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Correspondence to Fozia Z. Ahmed.

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Ahmed, F.Z., Khattar, R.S., Zaidi, A.M. et al. Pacing-induced cardiomyopathy: pathophysiological insights through matrix metalloproteinases. Heart Fail Rev 19, 669–680 (2014). https://doi.org/10.1007/s10741-013-9390-y

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