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
. 2021;28(3):423-430.
doi: 10.5603/CJ.a2019.0088. Epub 2019 Sep 6.

Predictors of pacing-dependency in patients with cardiovascular implantable electronic devices

Wolfram Grimm  1 , Kathrin Grimm  2 , Brandon Greene  3 , Mariana Parahuleva  2
Affiliations

Predictors of pacing-dependency in patients with cardiovascular implantable electronic devices

Wolfram Grimm et al. Cardiol J. 2021.

Abstract

Background: Data on the prevalence and predictors for the development of pacing-dependency in patients with cardiovascular implantable electronic devices (CIEDs) are sparse.

Methods: Pacing-dependency defined as an absence of intrinsic rhythm of ≥ 30 bpm was determined in 802 consecutive patients with CIEDs who visited the documented pacemaker or implantable cardioverter- defibrillator outpatient clinic for routine follow-up.

Results: A total of 131 (16%) patients were found to be pacing-dependent 67 ± 70 months after CIED implant. Multivariate analysis revealed a significant association between pacing-dependency and the following clinical variables: second or third-degree atrioventricular (AV) block at implant (OR = 19.9; 95% CI: 10.9-38.5, p < 0.01), atrial fibrillation at implant (OR = 2.15; 95% CI: 1.16-4.05, p = 0.02), left ventricular ejection fraction (LVEF) ≤ 30% (OR = 2.06; 95% CI: 1.03-4.15, p = 0.04), B-type natriuretic peptide (BNP) > 150 pg/mL (OR = 2.12; 95% CI: 1.16-3.97, p = 0.02), chronic kidney disease (OR = 1.86; 95% CI: 1.08-3.26, p = 0.03), and follow-up duration after implantation > 5 years (OR = 3.29; 95% CI: 1.96-5.64, p < 0.01). None of the remaining clinical variables including age, gender, diabetes mellitus, underlying heart disease, prior cardiac surgery or medication during follow-up including betablockers and amiodarone predicted pacing-dependency.

Conclusions: Pacing-dependency is associated with second or third-degree AV-block at implant, atrial fibrillation before implant, low LVEF, elevated BNP, chronic kidney disease and follow-up duration after implant.

Keywords: implantable cardioverter- -defibrillator; pacing-dependency; permanent pacemaker.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: None declared

Figures

Figure 1
Figure 1
Electrocardiogram recordings with a paper speed of 25 mm/s showing typical examples of ventricular asystole following transient inhibition of pacing; A. Ventricular asystole due to third degree atrioventricular block (AVB) without ventricular escape rhythm in a patient with permanent atrial fibrillation; B. Ventricular asystole due to sinus arrest without escape rhythm in a patient with sinus node disease; C. Ventricular asystole due to third degree AVB without ventricular escape rhythm in a patient with second degree AVB type Mobitz at the time of pacemaker implant.
See this image and copyright information in PMC

References

    1. Brignole M, Auricchio A, Baron-Esquivias G, et al. ESC Committee for Practice Guidelines (CPG), Document Reviewers. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA) Eur Heart J. 2013;34(29):2281–2329. doi: 10.1093/eurheartj/eht150. - DOI - PubMed
    1. Steyers CM, 3rd, khera R, bhave P.Pacemaker dependency after cardiac surgery: a systematic review of current evidence PLoS One 201510e0140340 - PMC - PubMed
    1. Glikson M, Dearani JA, Hyberger LK, et al. Indications, effectiveness, and long-term dependency in permanent pacing after cardiac surgery. Am J Cardiol. 1997;80(10)(97):1309–1313. 00671–1. doi: 10.1016/s0002-9149. - DOI - PubMed
    1. Tang AS, Roberts RS, Kerr C, et al. Relationship between pacemaker dependency and the effect of pacing mode on cardiovascular outcomes. Circulation. 2001;103(25):3081–3085. doi: 10.1161/01.cir.103.25.3081. - DOI - PubMed
    1. Nagatomo T, Abe H, Kikuchi K, et al. New onset of pacemaker dependency after permanent pacemaker implantation. Pacing Clin Electrophysiol. 2004;27(4):475–479. doi: 10.1111/j.1540-8159.2004.00466.x. - DOI - PubMed