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
Review
. 2023 Aug;41(3):449-461.
doi: 10.1016/j.ccl.2023.03.010.

Pacing-Induced Cardiomyopathy

Shaan Khurshid  1 , David S Frankel  2
Affiliations
Review

Pacing-Induced Cardiomyopathy

Shaan Khurshid et al. Cardiol Clin. 2023 Aug.

Abstract

Right ventricular (RV) pacing-induced cardiomyopathy (PICM) is typically defined as left ventricular systolic dysfunction resulting from electrical and mechanical dyssynchrony caused by RV pacing. RV PICM is common, occurring in 10-20% of individuals exposed to frequent RV pacing. Multiple risk factors for PICM have been identified, including male sex, wider native and paced QRS durations, and higher RV pacing percentage, but the ability to predict which individuals will develop PICM remains modest. Biventricular and conduction system pacing, which better preserve electrical and mechanical synchrony, typically prevent the development of PICM and reverse left ventricular systolic dysfunction after PICM has occurred.

Keywords: Heart failure; Pacing; Pacing-induced cardiomyopathy.

PubMed Disclaimer

Figures

Fig. 1.
Fig. 1.
Pathophysiology of PICM. An overview of the pathophysiology of PICM is depicted. Chronic exposure to RVP results in electrical dyssynchrony (manifested as a wide paced QRS complex) and mechanical dyssynchrony, including regional differences in myocardial contraction. Particularly in the presence of certain risk factors, electrical and mechanical dyssynchrony can lead to adverse remodeling and development of systolic dysfunction, manifesting in PICM. The prevalence of PICM is 10% to 20% over long-term follow-up.
Fig. 2.
Fig. 2.
Treatment of PICM. An overview of the treatment of PICM is depicted. PICM can be treated effectively with upgrade to a physiologic pacing strategy, either biventricular or conduction system pacing. Physiologic pacing leads to improvement of electrical synchrony (manifesting as narrowing of the paced QRS) and more synchronous intraventricular and interventricular contraction. Physiologic pacing leads to a substantial improvement in LVEF in 70% to 95% of individuals with PICM.
Fig. 3.
Fig. 3.
Improvement of pacing-induced cardiomyopathy following upgrade to physiologic pacing. Mean improvement in LVEF after cardiac resynchronization therapy (CRT) upgrade is illustrated within the first 3 months, 3 to 6 months, 6 to 12 months, 12 to 24 months, and more than 24 months among (A) the entire pacing-induced cardiomyopathy (PICM) cohort and (B) the severe PICM cohort (nadir LVEF ≤35%). The number of patients undergoing an echocardiogram during each time range is indicated below the x-axis. A proposed CRT implantation strategy is depicted (C) in which patients with severe PICM undergo initial CRT pacemaker with upgrade to defibrillator to be considered among those with LVEF ≤35% after 1 year. LVEF = left ventricular ejection fraction. Reprinted with permission from Khurshid S, Obeng-Gyimah E, Supple GE, Schaller RD, Lin D, Owens AT, Epstein AE, Dixit S, Marchlinski FE, Frankel DS. Reversal of Pacing-Induced Cardiomyopathy Following Cardiac Resynchronization Therapy. JACC Clin Eletrophysiol. 2018 Feb;4(2):168–177.
See this image and copyright information in PMC

References

    1. Andersen HR, Thuesen L, Bagger JP, et al. Prospective randomised trial of atrial versus ventricular pacing in sick-sinus syndrome. Lancet 1994;344(8936): 1523–8. - PubMed
    1. Mond HG, Proclemer A. The 11th world survey of cardiac pacing and implantable cardioverter-defibrillators: calendar year 2009–a World Society of Arrhythmia’s project. Pacing Clin Electrophysiol 2011;34(8):1013–27. - PubMed
    1. Yu C-M, Chan JY-S, Zhang Q, et al. Biventricular pacing in patients with bradycardia and normal ejection fraction. N Engl J Med 2009;361(22): 2123–34. - PubMed
    1. Vijayaraman P, Herweg B, Dandamudi G, et al. Outcomes of His-bundle pacing upgrade after long-term right ventricular pacing and/or pacing-induced cardiomyopathy: insights into disease progression. Heart Rhythm 2019;16(10):1554–61. - PubMed
    1. Chung ES, St John Sutton MG, Mealing S, et al. Economic value and cost-effectiveness of biventricular versus right ventricular pacing: results from the BLOCK-HF study. J Med Econ 2019;22(10): 1088–95. - PubMed