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
. 2024 Feb;47(2):336-341.
doi: 10.1111/pace.14929. Epub 2024 Jan 25.

Cardiac resynchronization therapy for pacing induced cardiomyopathy: Role of baseline right ventricular pacing burden

Ahmed Shahab  1 , Sean Lacy  2 , Jonathan K Chandler  3 , Seth H Sheldon  1 , Rhea C Pimentel  1 , Raghuveer A Dendi  1 , Rigoberto R Ramirez  1 , Martin P Emert  1 , Loren D Berenbom  1 , Y Madhu Reddy  1 , Nachiket Apte  4 , Amit Noheria  1
Affiliations

Cardiac resynchronization therapy for pacing induced cardiomyopathy: Role of baseline right ventricular pacing burden

Ahmed Shahab et al. Pacing Clin Electrophysiol. 2024 Feb.

Abstract

Background: Cardiac resynchronization therapy (CRT) is indicated for patients with heart failure with reduced left ventricular ejection fraction (LVEF) and chronic right ventricular (RV) pacing burden ≥40% (pacing-induced cardiomyopathy, PICM). It is uncertain whether baseline RV pacing burden impacts response to CRT.

Methods: We conducted a retrospective study of all CRT upgrades for PICM at our hospital from January 2017 to December 2018. Univariate and multivariable-adjusted changes in LVEF, and echocardiographic response (≥10% improvement in LVEF) at 3-12 months post-CRT upgrade were compared in those with RV pacing burden ≥90% versus <90%.

Results: We included 75 patients (age 74 ± 11 years, 71% male) who underwent CRT upgrade for PICM. The baseline RV pacing burden was ≥90% in 56 patients (median 99% [IQR 98%-99%]), and <90% in 19 patients (median 79% [IQR 73%-87%]). Improvement in LVEF was greater in those with baseline RV pacing burden ≥90% versus <90% (15.7 ± 9.3% vs. 7.5 ± 9.6%, p = .003). Baseline RV pacing burden ≥90% was a strong predictor of an improvement in LVEF ≥10% after CRT upgrade both in univariate and multivariate-adjusted models (p = .005 and .02, respectively).

Conclusion: A higher baseline RV pacing burden predicts a greater improvement in LVEF after CRT upgrade for PICM.

Keywords: CRT response; cardiac resynchronization therapy; chronic right ventricle pacing; heart failure; pacing-induced cardiomyopathy.

PubMed Disclaimer

References

REFERENCES

    1. Noheria A, Sodhi S, Orme GJ. The evolving role of electrocardiography in cardiac resynchronization therapy. Curr Treat Options Cardiovasc Med. 2019;21:91. doi:10.1007/s11936-019-0784-6
    1. Andersen HR, Thuesen L, Bagger JP, Vesterlund T, Thomsen PE. Prospective randomised trial of atrial versus ventricular pacing in sick-sinus syndrome. Lancet. 1994;344:1523-1528. doi:10.1016/s0140-6736(94)90347-6
    1. Nielsen JC, Kristensen L, Andersen HR, Mortensen PT, Pedersen OL, Pedersen AK. A randomized comparison of atrial and dual-chamber pacing in 177 consecutive patients with sick sinus syndrome: echocardiographic and clinical outcome. J Am Coll Cardiol. 2003;42:614-623. doi:10.1016/s0735-1097(03)00757-5
    1. Nielsen JC, Andersen HR, Thomsen PE, et al. Heart failure and echocardiographic changes during long-term follow-up of patients with sick sinus syndrome randomized to single-chamber atrial or ventricular pacing. Circulation. 1998;97:987-995. doi:10.1161/01.cir.97.10.987
    1. Kiehl EL, Makki T, Kumar R, et al. Incidence and predictors of right ventricular pacing-induced cardiomyopathy in patients with complete atrioventricular block and preserved left ventricular systolic function. Heart Rhythm. 2016;13:2272-2278. doi:10.1016/j.hrthm.2016.09.027