Sung Woo Cho1, Hye Bin Gwag2, Jin Kyung Hwang3, Kwang Jin Chun4, Kyoung-Min Park2, Young Keun On2, June Soo Kim2, Seung-Jung Park2. 1. Division of Cardiology, Department of Internal Medicine, College of Medicine, Inje University, Seoul Paik Hospital, Seoul, Korea. 2. Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 3. Division of Cardiology, Department of Medicine, Veterans Health Service Medical Center, Seoul, Korea. 4. Division of Cardiology, Department of Internal Medicine, Kangwon National University College of Medicine Hospital, Chuncheon, Korea.
Abstract
AIMS: We investigated the clinical features, predictors, and long-term prognosis of pacing-induced cardiomyopathy (PiCM). METHODS AND RESULTS: From a retrospective analysis of 1418 consecutive pacemaker patients, 618 were found to have a preserved baseline left ventricular ejection fraction (LVEF), follow-up echocardiographic data, and no history of heart failure (HF). PiCM was defined as a reduction in LVEF (< 50%) along with either (i) a ≥ 10% decrease in LVEF, or (ii) new-onset regional wall motion abnormality unrelated to coronary artery disease. PiCM occurred in 87 of 618 patients (14.1%), with a decrease in mean LVEF from 60.5% to 40.1%. The median time to PiCM was 4.7 years. Baseline left bundle branch block, wider paced QRS duration (≥ 155 ms), and higher ventricular pacing percentage (≥ 86%) were identified as independent predictors of PiCM in multivariate logistic regression analysis. The risk of PiCM increased gradually with the number of identified predictors, becoming more significant in the presence of two or more predictors (P < 0.001). During the entire follow-up (median 7.2 years), the risk of all-cause death or HF admission was significantly higher in patients with PiCM compared to those without PiCM (38.3% vs. 54.0%, adjusted hazard ratio 2.93; 95% confidence interval 1.82-4.72; P < 0.001). CONCLUSION: Pacing-induced cardiomyopathy patients showed a worse long-term prognosis than those without PiCM. Therefore, patients with multiple risk factors of PiCM should be monitored carefully even if their left ventricular systolic function is preserved initially. A timely upgrade to a biventricular or His-bundle pacing device needs to be considered in patients with PiCM.
AIMS: We investigated the clinical features, predictors, and long-term prognosis of pacing-induced cardiomyopathy (PiCM). METHODS AND RESULTS: From a retrospective analysis of 1418 consecutive pacemaker patients, 618 were found to have a preserved baseline left ventricular ejection fraction (LVEF), follow-up echocardiographic data, and no history of heart failure (HF). PiCM was defined as a reduction in LVEF (< 50%) along with either (i) a ≥ 10% decrease in LVEF, or (ii) new-onset regional wall motion abnormality unrelated to coronary artery disease. PiCM occurred in 87 of 618 patients (14.1%), with a decrease in mean LVEF from 60.5% to 40.1%. The median time to PiCM was 4.7 years. Baseline left bundle branch block, wider paced QRS duration (≥ 155 ms), and higher ventricular pacing percentage (≥ 86%) were identified as independent predictors of PiCM in multivariate logistic regression analysis. The risk of PiCM increased gradually with the number of identified predictors, becoming more significant in the presence of two or more predictors (P < 0.001). During the entire follow-up (median 7.2 years), the risk of all-cause death or HF admission was significantly higher in patients with PiCM compared to those without PiCM (38.3% vs. 54.0%, adjusted hazard ratio 2.93; 95% confidence interval 1.82-4.72; P < 0.001). CONCLUSION: Pacing-induced cardiomyopathypatients showed a worse long-term prognosis than those without PiCM. Therefore, patients with multiple risk factors of PiCM should be monitored carefully even if their left ventricular systolic function is preserved initially. A timely upgrade to a biventricular or His-bundle pacing device needs to be considered in patients with PiCM.
Authors: Kyeongmin Byeon; Hye Ree Kim; Seung-Jung Park; Young Jun Park; Ji-Hoon Choi; Ju Youn Kim; Kyoung-Min Park; Young Keun On; June Soo Kim Journal: J Clin Med Date: 2022-04-28 Impact factor: 4.964
Authors: Andres Di Leoni Ferrari; Guilherme Ferreira Gazzoni; Luis Manuel Ley Domingues; Jessica Caroline Feltrin Willes; Gustavo Chiari Cabral; Flavio Vinicius Costa Ferreira; Laura Orlandini Lodi; Gustavo Reis Journal: Arq Bras Cardiol Date: 2022-02 Impact factor: 2.000