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Incidence and predictors of pacemaker-induced cardiomyopathy with comparison between apical and non-apical right ventricular pacing sites

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Abstract

Background

Asynchronous activation of left ventricle (LV) due to chronic right ventricular (RV) pacing has been known to predispose to LV dysfunction. The predictors of LV dysfunction remain to be prospectively studied. This study was designed to follow up patients with RV pacing to look for development of pacing-induced cardiomyopathy (PiCMP), identify its predictors and draw comparison between apical vs non-apical RV pacing sites.

Methods

Three hundred sixty-three patients undergoing dual-chamber and single-chamber ventricular implants were enrolled and followed up. Baseline clinical parameters; paced QRS duration and axis; RV lead position by fluoroscopy; LV ejection fraction (LVEF) by Simpson’s method on transthoracic echocardiography (TTE); intraventricular dyssynchrony (septal-posterior wall contraction delay) and interventricular dyssynchrony (aortopulmonary ejection delay) on TTE were recorded. The patients were followed up at 6–12 monthly interval with estimation of LVEF and pacemaker interrogation at each visit. Pacemaker-induced cardiomyopathy (PiCMP) was defined as a fall in ejection fraction of 10% as compared to the baseline LVEF. Patients developing PiCMP were compared to other patients to identify predictors.

Results

The mean age of study population was 59.8 years, 68.3% being males. Fifty-one percent and 49% patients underwent VVIR and DDDR pacemaker implantation, respectively. After attrition, 254 patients were analysed. PiCMP developed in 35 patients (13.8%) over a mean follow-up of 14.5 months. After multivariate analysis, burden of ventricular pacing > 60% [HR 4.26, p = 0.004] and interventricular dyssynchrony (aortopulmonary ejection delay > 40 msec) [HR 3.15, p = 0.002] were identified as predictors for PiCMP in patients undergoing chronic RV pacing. There was no effect of RV pacing site (apical vs non-apical) on incidence of PiCMP [HR 1.44, p = 0.353).

Conclusions

Incidence of PiCMP with RV pacing was found to be 13.8% over a mean follow-up of 14.5 months. Burden of right ventricular pacing and interventricular dyssynchrony were identified as the most important predictors for the development of PiCMP. Non-apical RV pacing site did not offer any benefit in terms of incidence of PiCMP over apical lead position.

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References

  1. Shaw DB, Kekwick CA, Veale D, Gowers J, Whistance T. Survival in second degree atrioventricular block. Br Heart J. 1985;53:587–93.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Lamas GA, Orav EJ, Stambler BS, Ellenbogen KA, Sgarbossa EB, Huang SKS, et al. Quality of life and clinical outcomes in elderly patients treated with ventricular pacing as compared with dual-chamber pacing. Pacemaker Selection in the Elderly Investigators. N Engl J Med. 1998;338:1097–104.

    Article  CAS  PubMed  Google Scholar 

  3. De Cock CC, Giudici MC, Twisk JW. Comparison of the hemodynamic effects of right ventricular outflow-tract pacing with right ventricular apex pacing: a quantitative review. Europace. 2003;5:275–8.

    Article  PubMed  Google Scholar 

  4. Nielsen JC, Andersen HR, Thomsen PEB, Thuesen L, Mortensen PT, Vesterlund T, et al. Heart failure and echocardiographic changes during long-term follow-up of patients with sick sinus syndrome randomized to singlechamber atrial or ventricular pacing. Circulation. 1998;97:987–95.

    Article  CAS  PubMed  Google Scholar 

  5. Andersen HR, Thuesen L, Bagger JP, Vesterlund T, Thomsen PE. Prospective randomised trial of atrial versus ventricular pacing in sick-sinus syndrome. Lancet. 1994;344:1523–8.

    Article  CAS  PubMed  Google Scholar 

  6. Nielsen JC, Kristensen L, Andersen HR, Mortensen PT, Pedersen OL, Pedersen AK. A randomized comparison of atrial and dual-chamber pacing in 177 consecutive patients with sick sinus syndrome: echocardiographic and clinical outcome. J Am Coll Cardiol. 2003;42:614–23.

    Article  PubMed  Google Scholar 

  7. Sweeney MO, Hellkamp AS. Heart failure during cardiac pacing. Circulation. 2006;113:2082–8.

    Article  PubMed  Google Scholar 

  8. Schwaab B, Frohlig G, Alexander C, et al. Influence of right ventricular stimulation site on left ventricular function in atrial synchronous ventricular pacing. J Am Coll Cardiol. 1999;33:317–23.

    Article  CAS  PubMed  Google Scholar 

  9. Chan NY, Yuen HC, Choy CC, Mok NS, Tsui PT, Lau CL, et al. Left ventricular volumes and systolic function after long-term right ventricular pacing may be predicted by paced QRS duration, but not pacing site. Heart Lung Circ. 2014;23:43–8.

    Article  PubMed  Google Scholar 

  10. Dreger H, Maethner K, Bondke H, Baumann G, Melzer C. Pacing-induced cardiomyopathy in patients with right ventricular stimulation for >15 years. Europace. 2012;14:238–42.

    Article  PubMed  Google Scholar 

  11. Yu CM, Chan JY, Zhang Q, Omar R, Yip GW, Hussin A, et al. Biventricular pacing in patients with bradycardia and normal ejection fraction. N Engl J Med. 2009;361:2123–34.

    Article  CAS  PubMed  Google Scholar 

  12. 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;11:1619–25.

    Article  PubMed  Google Scholar 

  13. Kiehl EL, Makki T, Kumar R, Gumber D, Kwon D, Rickard JW, et al. Incidence and predictors of right ventricular pacing-induced cardiomyopathy in patients with complete atrioventricular block and preserved left ventricular systolic function. Heart Rhythm. 2016;13:2272–8.

    Article  PubMed  Google Scholar 

  14. Curtis AB, Worley S, Adamson PB, Chung E, Niazi I, Sherfesee L, et al. Biventricular pacing for atrioventricular block and systolic dysfunction (BLOCK-HF). New Engl J Med. 2013;368:1585–93.

    Article  CAS  PubMed  Google Scholar 

  15. Kindermann M, Hennen B, Jung J, Geisel J, Bohm M, Frohlig G. Biventricular versus conventional right ventricular stimulation for patients with standard pacing indication and left ventricular dysfunction: the Homburg Biventricular Pacing Evaluation (HOBIPACE). J Am Coll Cardiol. 2006;47:1927–37.

    Article  PubMed  Google Scholar 

  16. Martinelli Filho M, de Siqueira SF, Costa R, Greco OT, Moreira LF, D’Avila A, et al. Conventional versus biventricular pacing in heart failure and bradyarrhythmia: the COMBAT study. J Card Fail. 2010;16:293–300.

    Article  PubMed  Google Scholar 

  17. Mera F, De Lurgio DB, Patterson RE, Merlino JD, Wade ME, Leon AR. A comparison of ventricular function during high right ventricular septal and apical pacing after his-bundle ablation for refractory atrial fibrillation. Pacing Clin Electrophysiol. 1999;22:1234–9.

    Article  CAS  PubMed  Google Scholar 

  18. Tse HF, Yu C, Wong KK, Tsang V, Leung YL, Ho WY, et al. Functional abnormalities in patients with permanent right ventricular pacing: the effect of sites of electrical stimulation. J Am Coll Cardiol. 2002;40:1451–8.

    Article  PubMed  Google Scholar 

  19. Stambler BS, Ellenbogen K, Zhang X, et al. Right ventricular outflow versus apical pacing in pacemaker patients with congestive heart failure and atrial fibrillation. J Cardiovasc Electrophysiol. 2003;14:1180–6.

    Article  PubMed  Google Scholar 

  20. Domenichini G, Sunthorn H, Fleury E, Foulkes H, Stettler C, Burri H. Pacing of the interventricular septum versus the right ventricular apex: a prospective, randomized study. Eur J Intern Med. 2012;23:621–7.

    Article  PubMed  Google Scholar 

  21. Shimony A, Eisenberg MJ, Filion KB, Amit G. Beneficial effects of right ventricular non-apical vs apical pacing: a systematic review and meta-analysis of randomized controlled trials. Europace. 2012;14:81–91.

    Article  PubMed  Google Scholar 

  22. Kaye GC, Linker NJ, Marwick TH, Pollock L, Graham L, Pouliot E, et al. Effect of right ventricular pacing lead site on left ventricular function in patients with high grade atrioventricular block: results of the PROTECT-PACE study. Eur Heart J. 2015;36:856–62.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, All India Institute of Medical Sciences, 7th Floor, Cardiothoracic Sciences Centre, New Delhi, 110029, India

    Raghav Bansal, Neeraj Parakh, Anunay Gupta, Rajnish Juneja, Nitish Naik, Rakesh Yadav, Gautam Sharma, Ambuj Roy, Sunil Kumar Verma & Vinay Kumar Bahl

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  1. Raghav Bansal
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  2. Neeraj Parakh
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  3. Anunay Gupta
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  4. Rajnish Juneja
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Correspondence to Neeraj Parakh.

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Bansal, R., Parakh, N., Gupta, A. et al. Incidence and predictors of pacemaker-induced cardiomyopathy with comparison between apical and non-apical right ventricular pacing sites. J Interv Card Electrophysiol 56, 63–70 (2019). https://doi.org/10.1007/s10840-019-00602-2

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  • DOI: https://doi.org/10.1007/s10840-019-00602-2

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