Incidence and predictors of pacemaker induced cardiomyopathy: A single-center experience

Abstract

Background: Pacemaker induced Cardiomyopathy (PICM) is an easily overlooked cause of heart failure with reduced ejection fraction. Data regarding this complication are sparse. Therefore, the aim of this study was to identify the incidence and predictors of PICM.

Methods: Between 2011 and 2017, 857 consecutive patients undergoing pacemaker (PM) implantation, were reviewed, and according to our inclusion criteria 173 individuals were enrolled in this retrospective single center study. All patients included had normal left ventricular ejection fraction (LVEF) before implantation, underwent single-chamber ventricular or dual-chamber PM implantation, had RV pacing burden ≥20%, and repeated echocardiogram was available ≥1 year after implantation. PICM was defined as deterioration LVEF ≥10%, resulting in LVEF <50%, which cannot be explained by other causes.

Results: During a mean follow-up of 39.9 ± 21.0 months, PICM occurred in 26 patients (16%). RV pacing percentage did not differ significantly between the both groups (76.5 vs 76.2%, p = 0.65). The PICM group patients were likely to be men (p = 0.002) and had a lower rate of arterial hypertension (p = 0.01). Multivariate analysis revealed male sex (HR 6.45, 0.95 CI 1.90-21.86, p = 0.003) and wider paced QRS complex (HR 1.04, 95% CI 1.02-1.07, p < 0.001) as predictors of PICM.

Conclusions: In patients with frequent RV pacing, the prevalence of PICM is not uncommon. Male sex and wider paced QRS complex are independent predictors of PICM and these patients may require closer follow-up.

Keywords: Cardiomyopathy; Pacemaker induced cardiomyopathy; Pacemakers; RV pacing.