Predictors of right ventricular pacing-induced left ventricular dysfunction in pacemaker recipients with preserved ejection fraction

BackgroundPacing is an effective treatment in the management of patients with bradyarrhythmias. Chronic right ventricular pacing may cause electrical and mechanical dyssynchrony leading to a deterioration of left ventricular ejection fraction (LVEF). This deterioration of LVEF has been described as pacing-induced cardiomyopathy (PICM). The incidence of PICM has been described by many studies, ranging between 10% and 26%. Predictors for PICM are not yet established—studies were limited by variations in the definition of PICM and the follow-up period. The authors studied the incidence and predictors of PICM in patients with preserved LVEF who underwent pacemaker implantation.Patients and methodsThis retrospective study included 320 patients that underwent single- or dual-chamber pacemaker implantation, with a mean follow up period of 4.7 ± 2.0 years. Implantable cardioverter defibrillator and cardiac resynchronization therapy patients were excluded from this study. Individuals that had a baseline LVEF ≥ 50% before implantation in transthoracic echocardiography were included in the study.ResultsOf the 320 patients included in the study, 45% were male, with a mean age 55.5 years. The incidence of PICM was 7.5%. Wider native QRS duration, particularly > 140 ms (P < 0.001), wider paced QRS (pQRS) duration > 150 ms (P < 0.001), low normal ejection fraction < 56% pre-implantation (P = 0.023) and increased LV end diastolic diameter (LVEDD) > 53 mm and LV end systolic diameter (LVESD) > 38 mm (P < 0.001) predicted the development of PICM. There was no association between burden of right ventricular pacing (P = 0.782) or pacing site (P = 0.876) and the development of pacemaker-induced cardiomyopathy.ConclusionRight ventricular pacing-induced left ventricular dysfunction is not uncommon, with an incidence of 7.5%. Wider native and paced QRS durations, low normal ejection fraction (< 56%) pre-implantation and increased LVEDD and LVESD post implantation are the most important predictors for the development of PICM.