Risk factors of pacing dependence and cardiac dysfunction in patients with permanent pacemaker implantation

Abstract

Aims: Right ventricular pacing (RVP) dependence could impair left ventricular ejection fraction (LVEF). This study aimed to illuminate the relationship between RVP proportion and LVEF, as well as disclosing independent predictors of RVP dependence.

Methods and results: Patients indicated for permanent pacemaker implantation were included (2016-2020). The ventricular pacing lead was placed in right ventricular apex or septum. Pacing mode programming followed universal standard. Electrocardiographic, echocardiographic, and serological parameters were collected. RVP dependence was defined according to its influence on LVEF. This study was of case-control design. Included patients were matched by potentially confounding factors through propensity score matching. A total of 1183 patients were included, and the mean duration of follow-up was 24 months. Percentage of RVP < 80% hardly influenced LVEF; however, LVEF tended to decrease with higher RVP proportion. High degree/complete atrioventricular block (AVB) [odds ratio (OR) = 5.71, 95% confidence interval (CI): 3.66-8.85], atrial fibrillation (AF) (OR = 2.04, 95% CI: 1.47-2.82), percutaneous coronary intervention (PCI) (OR = 2.89, 95% CI: 1.24-6.76), maximum heart rate (HR_max ) < 110 b.p.m. (OR = 2.74, 95% CI: 1.58-4.76), QRS duration > 120 ms (OR = 2.46, 95% CI: 1.42-4.27), QTc interval > 470 ms (OR = 2.01, 95% CI: 1.33-3.05), and pulmonary artery systolic pressure (PASP) > 40 mmHg (OR = 1.93, 95% CI: 1.46-2.56) were proved to predict RVP dependence.

Conclusions: High RVP percentage (>80%) indicating RVP dependence significantly correlates with poor prognosis of cardiac function. High degree/complete AVB, AF, ischaemic aetiology, PCI history, HR_max < 110 b.p.m., QRS duration > 120 ms, QTc interval > 470 ms, and PASP > 40 mmHg were verified as independent risk factors of RVP dependence.

Keywords: Cardiac dysfunction; Pacemaker; Pacing dependence; Right ventricular pacing.

Figure 1

Flow chart of patient filtration and further selection by propensity score matching. CRT, cardiac resynchronization therapy; ICD, implantable cardioverter defibrillator; LBB, left bundle branch; VPD, ventricular pacing condition.

Figure 2

Distribution of different RVP proportion in included patients and related changes of left ventricular ejection fraction. (A) The RVP percentage was evenly divided into 10 groups: 0–10%, 10–20%, 20–30%, 30–40%, 40–50%, 50–60%, 60–70%, 70–80%, 80–90%, and 90–100%. (B) The cumulative incidence curve showed the differential occurrence of different percentage of RVP (>50%, >60%, >70%, >80%, and >90%) as endpoint. RVP, right ventricular pacing.

Figure 3

The trend of LVEF change in patients with different range of right ventricular pacing proportion. (A) Changes of LVEF at different time‐point during follow‐up. (B) Trends of LVEF in VPD group and non‐VPD group (cut‐off point of pacing proportion as 80%). LVEF, left ventricular ejection fraction; VPD, ventricular pacing condition.

Figure 4

The trend of QRS duration change in patients with different range of right ventricular pacing proportion. (A) Changes of QRS duration at different time‐point during follow‐up. (B) Trends of QRS duration in VPD group and non‐VPD group (cut‐off point of pacing proportion as 80%). VPD, ventricular pacing condition.

Figure 5

The trend of QTc interval change in patients with different range of right ventricular pacing proportion. (A) Changes of QTc interval at different time‐point during follow‐up. (B) Trends of QTc interval in VPD group and non‐VPD group (cut‐off point of pacing proportion as 80%). VPD, ventricular pacing condition.

Figure 6

The forest plot of multivariate analysis. AVB, atrioventricular block; CI, confidence interval; LBBB, left bundle branch block; PASP, pulmonary artery systolic pressure; PCI, percutaneous coronary intervention; RBBB, right bundle branch block.