Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jul 22;24(1):23.
doi: 10.1186/s40001-019-0386-5.

Pacing-induced cardiomyopathy in chronic right ventricular apical pacing: a midterm follow-up study

Erdal Safak  1   2   3 , Hüseyin Ince  4 , Lito Gkouvatsou  5 , Heinz-Peter Schultheiss  6 , Jasmin Ortak  4 , Evren Caglayan  7 , Alper Oener  7 , Giuseppe D'Ancona  4
Affiliations

Pacing-induced cardiomyopathy in chronic right ventricular apical pacing: a midterm follow-up study

Erdal Safak et al. Eur J Med Res. .

Abstract

Background: Data concerning the effect of chronic right ventricular pacing in patients with normal left ventricular ejection fraction (LVEF%) are contradictory. The aim of this study is to evaluate the prevalence of pacing-induced cardiomyopathy (PICM) at midterm follow-up after permanent pacemaker implantation (PPM).

Methods: A series of 170 patients were submitted to PPM within our facility. Inclusion criteria were the absence of structural heart disease and a preserved LVEF% (> 45%) at the time of PPM. A midterm clinical and echocardiographic follow-up was performed, and data were collected and analyzed retrospectively. PICM was defined as follow-up LVEF ≤ 45%, dyskinesia during RV pacing, and the absence of other known causes of cardiomyopathy.

Results: At a median echocardiographic follow-up of 24.5 months (IQR 10.0-43.0 months), the overall mean LVEF% decreased from a preimplantation value of 66.7% (± 8.6%) to 63.2% (± 10.6%) (p < 0.0001). PICM occurred in 11 patients (6.5%). Patients developing PICM had a significantly lower preimplantation LVEF% (58.4 ± 8.0% vs. 67.3 ± 8.4%; p = 0.005), a trend for higher right ventricular pacing time rate (0.7 ± 0.3 vs. 0.5 ± 0.4; p = 0.1), a significantly lower rate of PPM indication for sick sinus syndrome (SSS) (18.2% vs. 61.0%; p = 0.009), and significantly higher rate of second-grade cardiac conduction block (36.4% vs. 11.3%; p = 0.03). At multivariate logistic regression, only preimplantation LVEF% (OR = 0.88; CI 0.80-0.96; p = 0.006) and the presence of SSS (OR = 0.1; CI 0.03-0.9; p = 0.04) were independently related (inverse relationship) to follow-up PICM.

Conclusions: In this selected PPM patient cohort with preserved LVEF%, the rate of PICM at midterm follow-up is relatively low, but its occurrence seems to be related to baseline LVEF% and PPM indication category.

Keywords: Cardiomyopathy; Left ventricular ejection fraction; Right ventricular pacing.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

References

    1. Lindner O, Vogt J, Baller D, Kammeier A, Wielepp P, Holzinger J, et al. Global and regional myocardial oxygen consumption and blood flow in severe cardiomyopathy with left bundle branch block. Eur J Heart Fail. 2005;7:225–230. doi: 10.1016/j.ejheart.2004.07.003. - DOI - PubMed
    1. Knaapen P, van Campen LM, de Cock CC, Götte MJ, Visser CA, Lammertsma AA, et al. Effects of cardiac resynchronization therapy on myocardial perfusion reserve. Circulation. 2004;110:646–651. doi: 10.1161/01.CIR.0000138108.68719.C1. - DOI - PubMed
    1. Donal E, Leclercq C, Linde C, Daubert JC. Effects of cardiac resynchronization therapy on disease progression in chronic heart failure. Eur Heart J. 2006;27:1018–1025. doi: 10.1093/eurheartj/ehi734. - DOI - PubMed
    1. Tops LF, Schalij MJ, Bax JJ. The effects of right ventricular apical pacing on ventricular function and dyssynchrony. J Am Coll Cardiol. 2009;54:764–776. doi: 10.1016/j.jacc.2009.06.006. - DOI - PubMed
    1. Wilkoff BL, Cook JR, Epstein AE, Greene HL, Hallstrom AP, Hsia H, Dual Chamber and VVI Implantable Defibrillator Trial Investigators 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;288:3115–3123. doi: 10.1001/jama.288.24.3115. - DOI - PubMed